AM I BEING SCAMMED???

Please HELP!!!! I have posted this question before,but still need answers!! I was covered for a Abdominoplasty by B/C B/S, my PS stated that they only pay $1500 for a panni and I will have to pay him $3000 difference since his fee is $4500 for a full abdominoplasty. But my approval letter says abdominoplasty not panni! I went to three PS and they all said the same thing, I will have to pay $3000-$5000 for the difference. Even though I was approved. EVERYONE I talked to here on CT Board has stated that once covered by insurance, they only paid for the normal co-pay ($5.00 to $100.00 depending on insurance). Well i even talk to a previous patient of my PS, her insurance covered a LBL and all she paid was $10.00.!!!!! Why am I being SO UNLUCKY???? Covered by insurance but still have to pay $3000??? Anyone PLEASE KNOW if there's someone at the ins company I can contact? I dont want to question my PS too much on this, because I dont want to get them mad, or should I? AM I BEING SCAMED?????!!!! ANY HELP AND OR SUGGESTIONS WILL BE APPRECIATED Sharon

Call your ins company and see how much they will pay for this abdominoplasty. They may have a "cap" as to how much they will pay. Then... Call the PS's office not as yourself but as "anon." and ask what the cost for an abdominoplasty is. Ask if there's a different cost for cash pay and ins pay. You should have your answer. If there is still confusion..Call the ins company back and tell them the situation. Maybe they can fill you in. You can then, afterwards, call the PS's office back and talk to the billing person and ask why you're being quoted such a high out of pocket fee. Don't be afraid of them, YOU'RE THE CONSUMER...You're paying them! Tell them to look at the approval letter again that it states abdominalplasty not panni...maybe they overlooked it. HOpe this helps. I don't know how else to help. But, keep on top of it and ask questions. paula

Sharon- you know what bother me about this? If the surgeon is charging you and charging the insurance, he is double dipping- which is a NO NO. He has a contract with your insurance provider to provide medically necessary services at a certain SET cost. If he isn't HAPPY with the contracted price for your medically necessary surgery, then he shouldn't be participating with your insurance company. So, what he's doing is getting money from the insurance then charging back to you the remainder of his "full" price that he would charge someone that doesn't have insurance. That's just NOT how it is supposed to work. It's like if you went to your PCP and were there for a check up but wound up spending two hours consulting with your doctor- he bills the insurance for a check up and gets paid the STANDARD charge, regardless of the fact that your checkup took two hours. Your PCP doesn't say- well- Gee, Sharon, you're taing up an awful lot of my time, so I'm going to bill you for my services on top of being reimbursed, because the insurance, well- they're just not paying me enougth for all this time!" It would be a different story if -say- for instance- you get a medically necessart TT that is approved by insurance and Insurance covers it...THEN at the same time you decide you want to have a breast lift- and the insurance DOESNT cover that... then the surgeon would charge you for the BL portion while charging the insurance for the TT portion. So-in short (after babbling) it just seems WRONG. I would speak to your insurance company about this practice- no names, of course, just a general conversation about the acceptability of it. best of luck, Lisa C

Thank you so much for all your great responses. I actually got a post on another board that stated that the most important thing is that I have a GOOD PS who is experienced in WLS patients. I know that my PS is a good surgeon, so I guess I am just gonna have to pay to have one of the best. I would have loved to not pay as much out-of-pocketm but oh well! I have been very lucky in this journey so far! Thank you all for your support, keep me in your prayers!!! June 29th is the day!!!!!!!!!!!!!! Sharon