Question:
Has anyone been approved by ins & asked to pay extra by surgeon?

I thought I would bring this to you guys since I know Dr's & lawyers are members too. I have gone through hell after a year of fighting insurance to pay, pre-op testing, & waiting for a date. I've invested a lot of time & effort into this surgeon. The other day he called all of his patients scheduled for the surgery & said his expenses have gone up & regardless if I am self pay or have insurance I have to pay $5,000 up front. I have researched this & it sounds like fraud. Is it true that if he is a member of my insurance group he has to accept what he has agreed to for payment & the patient is only required to pay the co-pay or deductible? Help-this can't be happening!! I really need to get this straightened out.    — Suzie .. (posted on December 18, 2001)

December 18, 2001
Man, that sounds like a total crock of bull. Yes, if he excepts that kind of insurance, he has sign a contract saying he will accept the amount of money they allow for certian things. You SHOULD NOT give him more money. You SHOULD call your insurance company and let them know what he is doing. This sounds like FRAUD to me. Helen
   — Helen A.

December 18, 2001
I agree with Helen.
   — Kristin R.

December 18, 2001
As well as agreeing with the others, I would also contact the AMA. Sounds fishy to me. If he is a contracted provider- he signed a contract accepting what the insurance will pay AND agrees not to bill you for anything over the contracted amount. I don't think I would have that doctor operate on me!! Good luck!
   — Cindy K.

December 18, 2001
People... get real. Surgeons have been doing this to poor old weight loss patients for a while now. We are such a desperate group we pay these fees even when tipped off by those of us who have figured these scams out. A Fort Lauderdale surgeon has charged patients a $2000 lap fee plus $800 for support groups and $1000 for unrequired psych exam fees since this procedure hit the big time. However... even when I tell his pre ops that what he is doing is greedy and unethical... they dont care. The insurance company doesnt care if the surgeon does the surgery on his head, lap or open... but this surgeon tells his patients the insurance company wont pay for lap and it costs the extra fee. They are lining up to see him!
   — [Anonymous]

December 19, 2001
Rubbish! If your insurance is paying, you are liable only for the co-pay and any deductibles. Call your insurance company, this guy signed a contract with them and they'd sure like to know that he's violating it! Another thing to think about.....do you really want such an unethical, money grubbing, sleaze bag operating on you? Could you trust such a person?
   — [Anonymous]

January 23, 2003
Ok I'm not saying that I agree with this fee but here's my experience. My Dr. says that I have to pay $3500 to him. Not all upfront.. kinda like a down payment then I have a year to pay it off. He made a joke about it paying the money for an extra 2 year warrenty for his services (hey I thought it was funny). Basically he flat out said that that's how he makes money. The insurance company only pays him 1500 for lap and about 1000 for the lap band, which I think is an insult to the doctors. *shrugs* hell I just might be nieve. I can't say for sure the information he gave me was correct. I know that he is just starting out doing the WLS but he's been doing lap surgeries for 13 years. He is working on developing his after care program and starting a support group. Maybe I am just a cash chucker as my roommate calls me on a weekly bassis! but I would rather pay $3500 and have the insurance pay the rest then pay $9000+ as a self pay. Besides didn't they just come out with a law that we can write off any costs associated with WLS on our taxes? *shrugs* anyways that's just my opinion, I don't claim to know anything other then that!
   — Sarah G.