Question:
HAVE OTHERS HAD TO PAY SURGEON FEE UP FRONT BEFORE SURGERY WITH INSURANCE APPROVAL

I thought I had done it. :-( I have approval from my insurance company, knew I would have to pay about 1,000 of my portion (60/40 plan) before the insurance would pick up the rest at 100%. I was excited to call the docs office only to be told that I HAVE to pay the surgeon's fee (4268) out of my pocket up front at least 1 week before surgery and then I'll get a date. Then once I have surgery my insurance company will be billed and what portion they don't pay of the surgeon fee will go toward what I've already paid! So if their allowable charge is only 3000 of the 4268, then I would be refunded 3,000 from the doc and I will have paid 1268. Now I realize that his fee includes lifetime care, but I thought this is why we have insurance coverage. There are allowable charges and WE (the consumer) should NOT be paying above what the insurance considers the allowable charge. Are others having this same problem or is this possibly because my doc hasn't worked with my insurance? My surgeon is Dr. Sifers in KC. PLEASE LET ME KNOW IF THIS IS THE NORM. If it is, I can accept it knowing that I will have to have surgey put off awhile to come up with that much, but at least I'll know it's not just me. THANKS IN ADVANCE!!!    — Click B. (posted on June 15, 2002)

June 15, 2002
Sharon, I think this is quite normal for doctors who do not participate in any insurance network. Mine requires $3500 upfront, or $5000 for Blue Cross/Blue Shield patients. Even though my insurance (if they approve me), will pay at IN-NETWORK benefits of 80/20 because there is no bariatric surgeon in their network, my doctor still requires the upfront money. I guess they don't trust the insurance either! The good news is that most people I have talked to get all or most of their money back within one year. I will probably forget about it by then, so that will be like winning a small lottery! Good luck to you! Ginger
   — Ginger N.

June 15, 2002
I had to pay $7,875 up front for the surgeon's fees. I doubt I will see any of that reimbursed. It sure would be nice, though!
   — Jennifer A.

June 15, 2002
I also will have to pay an upfront fee of $4500.00 Don't know where in the world I'll get it but I'll try. My doctor said it's because they have had instances where an insurance company said they approved and then after surgery they didn't pay. So I guess that's their way of getting their money for sure. As with the others, after insurance pays you will get reimbursed for whatever your portion of the policy is. Hope this helps.
   — angela D.

June 15, 2002
I had to pay my surgeon up front as well. It was $675- I have BCBS with a $1500 out of pocket ceiling. What ticked me a little was that I couldn't write a personal check- I had to go to the bank and get a $ order. But, perhaps he's helped lots of people and their checks bounced. I guess docs gotta eat, too.
   — Loretta E.

June 15, 2002
i dont mean to sound flippant, but i had to pay up front too, and i wanted surgery so bad, i would have come up with twice the amount. i had to scrimp and save for a year to come up with just the co-pay. i just finished paying off the charges i put on the credit card for traveling. my attitude towards the money part of this surgery is so changed since i am now 3 months post op and down almost 60 lbs. when post ops told me they would mortage their houses if they had to do it over, i laughed and said how foolish. but now that i am postop .......this surgery is priceless!
   — PATSY N.

June 16, 2002
My Doctor required a deposit of $1000 before surgery. After the insurance paid all they were going to, which was MOST of the remainder, the Doctor's office was good about taking regular payments til it was all paid off.
   — Kathy W.

June 16, 2002
Depends on your insurance carrier (of course) but mine suggested that I find a general surgeon with bariatric experience who was in our network - we don't have any bariatric surgeons in-network - and then all out of pocket would be just my deductable of $600 (of which I have about 300 for the year to pay). I took their advice and found a very competent general surgeon who does 1 or 2 bariatric surgeries a week (very successfully thank goodness!) and nothing up front is required! Woohoo. Would this route help you perhaps?
   — [Deactivated Member]

June 17, 2002
I had to pay my deductible up front. But after the surgery, my ins. paid the surgeon 100% so I got that money I paid in advance refunded back promptly. My hospital tried to get me to pay them up front for the deductible, but I informed them I had already paid the deductible amount in advance to my surgeon. They said that was fine and that I wouldn't have to pay them anything towards the surgery. I might mention, that I had to show them the receipt where I had paid the surgeon though.
   — lindajenkins