Being charged an application/insurance filing fee

Is this normal??? Do all surgeons charge this?


I was doing my paperwork for the consult w/ Dr. Macik.  Mind you, this was not stated during the consult nor when I made the appointment.  I'm filling out the paperwork and from what I surmised, it's to do the insurance paperwork.  The fee is $250.  A coworker of mine said his surgeon (Dr. Williams) charged $100 (also said that's all he paid OOP. Can't see how, cuz even though we have diff companies, the plans are set up exactly the same way - same co-pays, same coverage, etc).

A friend told me that is illegal, but if this is the norm...

I can see this damn surgery will have to wait until next year when I restart my FSA. Don't know if I should dip into rainy day fund for it.

And yes, I'm thinking a lot about it- you call it overthinking, I call it dotting my I's and crossing my T's.

This is the norm.  Most of the programs seem to charge some kind of fee that is not covered by insurance.  Depending on the doc, they say it's for different things.  Dr. Macik charges $250 to be paid when your stuff is ready for insurance submittal.  Dr Daly charges a $2500 "program fee"...I'm not sure what that covers or what it is for.  Maybe a Dr. Daly patient can clarify.  Emory downtown charges a $600 program fee.  This covers 2 or maybe 3 nutritionist visits as well as your support group visits.  Emory downtown does NOT allow anybody other than their own patients to attend their support groups.  I don't remember Dr. Hart/Johnson charging a fee, but the nutritionist was $50 a visit and I don't believe they would bill insurance for that.  And the program that LaShelle and Ahari U. are using in North Carolina has a program fee of $1300 (I think) but that covers some testing, and the patient may or may not be able to get some reimbursment from insurance...though the doc office will not submit it to insurance.

So, it's "the norm".

TalkSoupSLP is right, its normal.   The surgeon I was looking at in Augusta has it where you have to use his nutritionist and psych and have a charge for that.

Good luck, babygirl!! 

Thank you all!

I might have to put this off until next year. I do have a little bit in savings, but was finally trying to start saving for a rainy day.  I really wanted to do it this year, but I just made the decision last week.  I've met my deductibles, etc.  

I don't know...

Just more fees and don't know what will come out of pocket.  Dr. Macik's office said his fee would be approx. $300 for my co-insurance.  That can be handled one way or the other.  Its the other cost that I'm worried about.  I have 80/20 insurance.

check your insurance.  you should have an "out-of-pocket" maximum.  once you reach that point, you wouldn't be responsible for any other surgery or doctor fees.

For my insurance, the deductible was $1000 (now, $500 of that was covered with an HRA...long story on how that works, but it didn't come out of my pocket).  Now, I'm doing the 90/10 split with the insurance company.  Once i spend another $1000 (and trust me, this is coming fast and furious...a few hundred for a liver biopsy...$20 here for lab work...$30 there for upper GI...), for a total of $2000 out of pocket - I don't have to pay another thing for the rest of the year.  This includes doc visits...medications...lab work...etc.  Now, that $250 fee for Dr. Macik doesn't get counted with the insurance, but everything else does. 

Anyway, something you might want to look at.

I have a $2000 max. almost $500 has been used, deductible met.

They told me that my OOP w/ Dr. Macik would be $300 - but not including hospital and whatever else.

Familiar w/ HRA - work in benefits.

Do you know... well, you have a 90/10, may not help me know... I was going to ask if you didn't mind sharing your total OOP for Macik - you can PM if you don't mind sharing.  I have 80/20.

I don't know what my total out of pocket will be with Dr. Macik.  What I do know is that i've probably burned close to $500 of my out of pocket maximum.  Next week, I have an echocardiogram and a stress test.  I assume they are going to be pretty cheap with my coinsurance for each maybe being no greater than $50 each?????  Though I anticipate closer to $20.  So, let's say I've met $500 of my out of pocket max when I step into the operating room...the surgery will cost me $500 total to make up the rest of my out of pocket max.  Who gets the $500 just depends who bills quicker...Dr. Macik or Northside Hospital.

Are you doing the echo and stress test per Dr. Macik or are they just routine things yu are having done?  I am about to submit my paperwork to them for prior approval and was just wondering what to expect.

Dr. Macik's office makes you have an upper GI (I had one but mine was 10 months ago...they wanted 6 months or less), a pulmonology clearance and a cardiac clearance.  They told me which doc offices to use.  The pulmonologist had me do a breathing test and a chest xray - standard operating procedure.  They were done in his office and I was sent away with a signed form of clearance.  The cardiologist is making me do the stress test and echocardiogram.  I'm not 100% sure, but I think the stress test may be standard operating procedure for them and I think the echocardiogram is because I'm "special"   After the tests are done, unless they find something unusual, the cardiologist will clear me for surgery.

I'd rather them be extra cautious than not.

Don't puit off your surgery!  With the economy wls is one of the 1st things companies will drop from your benefits!   For a new life could you give up cable, cell phone, eating out, getting nails done, hairdresser, or anything else for a few months?


If you really pinch pennies you can come up with $300.

Try having a yard sale or selling some clothes on ebay.