Dr. Smith

Hello everyone, I am normally on the DS board but since Dr. Smith is in GA I thought I would come here for some advice also. I am so upset. First let me say that Dr. Smith is a great Dr. but I feel like I have been called a liar, have been lied to and now and out a bunch of $$$. Their website even states that they are not in network with any company but that "you would be responsible for whatever your in-network co-insurance would be." Please tell me what you think that means. Even if I paid 20% of the bill which would have been another $300 maybe, I would still be owed a refund because it would have been over my out of pocket max for the year. Karlene(Dr. Smith's office manager says that does not mean you max-out of pocket. She said that I was never told that all I had to pay was max out of pocket. I told her I really do not appriciate being called a liar. When I started the process with them I was told I would have to pay my max out of pocket up front. I asked many times if I would get a refund of what I would have already payed because I would have met my out of pocket max I was told yes a number of times by the office staff. She says that she is the only one that talks about insurance and $$ to people which is not true! So I paid my $2500 up front like I was suppose to. A week after surgery I started recieving bills for my pre-op test(like I should have) and when I talked to the insurance they said to wait that I really only owed Dr. Smith's office $610.12 and should be getting a refund. Now let me say that the insurance did not pay what the Dr.'s office wanted. I understand that they wanted them to pay more. BCBS said they paid what they would have if they were in network and can not make them right off the rest. I understand that they want more $$ from the insurance but should I have to pay because they make the agreement to accept the in-network and it is not what they want? So now not only have I paid my max-out of pocket to Dr. Smith but now I owe about another $2500 to the hospital and other Dr.'s office, lab work and so on. Dr.Smith's office was the last to file the claim so all of my deductables has went to all the other stuff. I am so upset that I am in tears. I don't know what to do! I told them that I wanted the wording changed so that no one else goes through this, Karlene said that they were working on that, well that is a little to late for me! I was contacted by a previous patient of Dr. Smiths and was warned about something like this, that is why I asked so many times about a refund. I am paying double the price for the surgery than I was suppose to. The insurance company stated that she knows what she is doing when they get their $ up front and tell's you this, that they really have no intentions of giving you your $$ back. I can not believe that Dr. Smith accepts that the patients are being deceived, he was so caring towards his patients. But he does know about my case because I sent a copy of the email I sent to Karlene to him. She also said today that he is reviewing the letter she is sending me explaining to me what I need to do to fight the insurance company to get them to pay them more $$. I just want everyone to know that Dr. Smith is a great Dr. and is worth every penny but be sure to know that it is going to cost you a lot more than you are counting on more than likely! If I would have know that then I would have waited a little longer to have the surgery, now we are in financial trouble and I am so angry that she had the nerve to tell me that it was never talked about or called max out of pocket. Has any of his other patients talked about max out of pocket with them or am I just completely wrong on this. If I am way off base then please let me know. Shaking with emotions, Patti

Patti, Have you gotten your (EOB) estimate of benfits. Everytime I get mine it has on the form what bcbs paid to the provider and what I am responsible for. Have you considered talking to the insurance comissioner? I think I have his number if you are interested. Also if you have a good PCP talk to the person who does the insurance and ask what should or can you do.

Thank you, that would be great. I do have the benefits page the insurnace sent me. You can just email it to me if you would like. Thanks, Patti