Am I being Scammed??

I went to see a surgeon and was told since I had UHC, only 1 of the doctors was contracted and the other doctor would be out of network. I would be required to pay 20% which is $1500 in addition to my copay of $400 at the hospital and my office visits. They told me I was lucky I had out of network benefits many do not have it. It would seem to me that both doctors in the practice would be contracted with same insurances. I called UHC and was told that I should ask for another assistant that is contracted but since they only have the 2 doctors thats not possible. UHC suggested I switch to another doctor if this was the way the practice was set up. She thought it was a little shady. She told me there are several other doctors I can go to that would not have this fee. I feel like I am being scammed out of extra money, like the one doctor takes it and the other doesn't so they can make more money. Is this normal? Should I just go somewhere else? Doesn't this sound illegal, immoral, unethical? Has anyone else had this problem? Thanks for your help, Linda

Hi Linda, I am with UHC but through state of AZ, which is self-insured so it is a different ball game. However, my plan description states that if my surgeon is an approved provider for UHC then any assistants, anethesiologists, nurses, etc. that are involved in the surgery are covered even if they are out-of-network. My plan description also states though that they cover negotiated or resonable fees for those services and that I may be billed for any charges that are not reasonable. It sounds like that may be what is occurring in your situation. It does sound like the surgeon's practice is just trying to make more money. Usually, they get paid a lot less by insurance than they would for self-pay patients so they may have their office structured so that they can compensate for the difference, which does seem shady to me. I don't think it is illegal. Maybe a little immoral or unethical but let's face it, medicine in this country is all about profit. If it wasn't we all wouldn't have to go to such a battle to get approval for WLS, which for most of us is a life saving procedure and at the minimum, a life extending procedure. I know that Dr. Blackstone, Dr. Juarez, and Dr. Fang all accept UHC and are highly recommended. Personally, I went the route of least burden on my finances since I am a paycheck-to-paycheck kinda gal. Hope this info helps. Take care, Sandi

Linda. I would think if they are under the same practice it seems they would be contracted under the same insurance. It sounds more like they are just sharing office space, and if so why are you required to see both doctors? Why can't you just see the doctor that takes your insurance?? That is the question I would ask. Perhaps I am not understanding the entire scenario though. I don't think they are actually trying to get more money out of you as they are going to get their money either way, from you or the insurance company. Just sounds like they have complicated things for themselves and the patient by running an office that has you in network 50% of the time, and out 50% of the time. It has to be a billing nightmare for their billing department as well as obviously very confusing for their patients. I would go with your gut feeling about it. You don't want to get to far into this and then change your mind and have to start over. If you are skeptic now it might be a sign that it is not the doctors office for you. I've heard lots of people say "they wish they had" when it was already to late.. And you don't want to get 6 months down the road and have to start all over. Good luck with this. I know it isn't easy.

Thanks for the help, I was told they are a 2 surgeon office. I did leave the office without paying anything. The man that explained it all seemed to be money hungry and pre-occupied. He was a jerk now that I think about it. Wanted me to get some credit plan that was expensive too. I really think they are scammers but I saw some of the patients they had and they all looked great. I am going to go to Dr Fang or Dr Juarez now, all I will have to pay is my copays and the hospital copay , psycologist fee too so less than $700 out of pocket Not the $4000 that they wanted! No support fee or jacked up charges. I have to start over with the seminar but thats ok, I will save money and not feel scammed. We do this to better our lives and not be taken advantage of! Thats bad to be taking advantage of a obese desperate person!!! Glad I have this support group here! Linda

Linda, I'm glad your started with someone new, and a new seminar isn't a bad thing. You may learn some things you didn't in the other one. Heck I would recommend going to eveyones seminars. They don't sound like a nice office. I'm glad you found this out before it was too late.

Dr Fang is awesome Good choice!

Hi SNLFAN! I just wanted to say I work for an insurance company...not UHC but another big company and it is possible to providers under one office to have different contracts with a insurance company and this can be the case for several reasons. Not sure if your being scammed but the situation is possible.  Hope that helps.