need advice! bc/bs problems
I went to see Dr. Frantzides in February already approved through Bc/Bs IL and he informed me he was out of network but not to worry that Bc/ Bs would reimburse me and I would pay him. he charges $12,635.00 for the procedure and wanted 50% up front so I took out a note loan with the assurance from the doctor that it would be reimbursed in plenty of time. Bc/Bs will only give me $1100.00 they say that's all they will pay even after 2 appeals!the idea that the doctor could perform this procedure laporoscopicly for $1100.00 if impossible but more importantly I have the note due in June and he wants the remainder and I'm up a creek!
Is there anything I can do or has anyone else been through this???
Gary if your reading please advise.
I had an attorney hear my situation that handles obesity law in California and his reply was:Hi TODD:
I have no idea why an out-of-network doctor would tell you that the plan would reimburse you in the manner that you say he told you....out of network coverage NEVER works that way. It sounds to me like the company did pay in accordance with the reduced fees for an out of network doctor; the "blame" as I see things seems to lie with the doctor's office who, if I have the facts straight, misled you in order for them to get maximum payment. Sorry, but this is the type of case we don't get involved with. I would seek out a local attorney in your area experienced with issues of fraud and misrepresentation; that sounds alot like what happened to you in this case.
Walter Lindstrom, Jr.
I don't want to be upset with the doctor but it looks more and more like I was worked for the $6500 down to ensure he got paid knowing Bc wasn't going to.
Any help would be appreciated!!!!!