Question:
Why are my out of pocket expenses keep going up and up?
I am Pre-op. Why do Dr's charge a cash fee up front even though you have ins that will pay for surgery. Called PSY doc for PSY esam and as soon as I mentioned that I wanted the exam for WLS she auto said you must first pay $500 before appt. This dr on my PPO list to go to and my co-pay is $15 for appt. So why is PSY dr ($500) and WLS dr ($600) also charging up front cash before surgery? Out of pocket expenses keep going up and up. I do not understand, pls someone expain to me. What's Up? — Tina B. (posted on June 27, 2008)
June 27, 2008
When I had my psych evaluation I had to pay for the visit up front, but
then they billed my insurance and sent me a refund - my insurance only
covered 50% of that, which kinda sucked since they pay 80% of everything
else and our regular mental health benefits are great. Anyway, from what I
have heard, it is common practice for therapists to charge up front when
they do WLS evaluations. As far as my surgeon went, his office
pre-authorized my surgery and determined that my copay would be $400, so
that was the amount I had to pay up front. Your insurance may not cover
surgical procedures in the same manner they would a regular doctor visit,
which is why you're having to pay more than your $15 copay. If you have
questions about why the are charging you up front or about the amount they
are charging you, don't be afraid to ask - you have the legal right to
know!
— lauren_marie
June 27, 2008
Hi - I'm not sure about your doctor, but when I had my surgery, my MDs
office charged a $500 "program fee", which covered all the things
that they do not bill to my insurance company. It covered the required
pre-surgery inormational group meeting, any insurance-required weight loss
program meetings, and it also covers all of my nutritionist visits, which I
have every three months when I go for follow-ups with my surgeon. I also
have access to the WLS nutrition group between visits, via email and phone.
Good luck!
— sbonner
June 27, 2008
When I went for my psych exam, the only thing I had to pay was the co-pay.
I got a bill afterwards for what my insurance didn't cover.
— trinity1803
June 27, 2008
Are these guys a part of your plan. Find a psychiatrist that is in your
plan and then you can only pay the copay. I know in my area, there are dr's
who charge for fills. If a dr participates in your plan they cant charge
you. I dont know why people say they pay for stuff not covered by
insur...Like what? I only had to pay the nutritionist since they only cover
that if you have diabetes. I used to do this for a living...if you want to
email me I can try and help u. What ins do you have? linda
— Linda R.
June 27, 2008
Some surgery offices and their assocaited pre op doctors tend to "rip
people off" in the WLS process. Find another doctor in your insurance
coverage, who won't charge that up front fee. That is ridiculous. I had
surgery 26 months ago, and I NEVER paid anything over the standard office
visit. I even had my psych eval done with my standard psych doctor that I
see for anti depressante. I had the consult with him, paying only my
insurance deducatble, and he wrote a short report and faxed it to my
surgeon's office. You're not the first one to report these extra fees. My
surgeon accepted my insurance coverage too. You might consider reporting
said doctors to your insurance company for these "cash fees", as
that may not be allowed by your insurance company. For some insurance
carriers, these up front fees may be against their policies, and the
doctors may be at risk of losing their "listing" on allowable
doctors for that insurance company. DAVE
— Dave Chambers
June 27, 2008
Ok if any of your insurance's covered your psych eval you're quite lucky.
In NY at least where I live no insurance will cover the presurgical psych
exam, it's out of pocket. However...most charge $200 not $500.
Sorry had to input my 2 cents worth.
-Danielle
— Danielle T.
June 28, 2008
I know what you mean. My pysch was $400 - wasn't in my plan so went to out
of ppo deductible. Surgeron charged me $400 but billed the insurance and it
covered 100% so i am going to ask him for a refund. Had to pay the hospital
$1925. of which I am also do a refund because other bills came in before
they turned that in. I am only supposed to pay $2500 out of pocket a year.
I am already past that and not to mention sleep study, cardio stress test
and all the other tests and bloodwork.
Arden
— bikermama
June 28, 2008
it will depend on the type of ins you have. (also the doc's-he/she may
have been burned on pymts for wls in the past but its still wrong) I was
very lucky. My HMO PacifiCare (thru my own employer which was/is still one
of the largest hospitals in calif ) took 5 dollars copay for the seminar,
nothing (or maybe 5 ) for the nut, 5 for the psych eval, and 5 for the
surgeon consult. Since i was over 50, the most it cost was 10 for the EKG,
5 for the chemical treadmill, and nothing for the pre-op tests, blood work,
GB ultra sound, blood gasses ect. No charge for follow ups either for 6
months. By then i didnt have my ins anymore, but all was well. Call your
employer/ins co and find out what can be charged-if they are playing you
for money-find a surgeon/hosp within your ins program and change.
good luck Cindi -230lbs
— DollyDoodles
June 28, 2008
I had to pay $500 to my doctor too. It was their Weight Loss surgery
program fee to pay for the Baratric Nurse Line, Nutritionist, etc that does
not get covered and billed under your insurance. My doctor made a payment
plan for me as I also had to pay $1000 Out Of Pocket for my Deductible.
— Karen M.
June 28, 2008
check over your PPO plan. It will say what the deductibles are.
— bariatricdivalatina
June 28, 2008
Dave's answer is the best. My first surgeon was really the one that I have
bills for all these doctors that I NEVER saw and they wrote reports that
were not true and I DID contact my insurance company and they noticed that
some of the reports were dated before my visit to another doctor for these
tests...I smelled RIP OFF and due to other irregularities I changed
doctors...I only had to pay $10.46 co pay for my psyh appointment..I had to
pay for my surgery up front and when time come for the surgery, they
cancelled it because of corporate decision and was told it would be weeks
and weeks before it could be rescheduled...I changed doctors and I asked
for my money back 2-27-08 and I had to contact State Attorney General to
get money back which I finally recieved 5-20-08. The second surgeon had me
schedule on 4-16-08 and he didn't make me pay up front, nothing...Great
Surgeon
— dyates2948
June 29, 2008
My insurance covered NONE of my expenses, so even though it sounds like you
are spending a lot of money, try to be thankful.
It is my opinion that until such a time that obesity is recognized as
serious and deadly a disease as it actually is and ALL insurance companies
are forced to pay for WLS, some medical practioners will continue to reap
the financial rewards as we suffer.
Dawn Vickers, RN, BLC, CLC
— DawnVic
June 29, 2008
I agree with you! It seems after I got approval, and had already shelled
out money for the pre approval appointments, including the 6 months
supervised diet, it seems as if then the cashflow for me really started.
My insurance company pays 80 percent of my expenses. I am liable for the
rest. Now I have five appointments before my surgery. And I dread what my
20 percent will be for these five appoitnments. I am grateful, though, to
have this opportnity. I just hope that I have enough funds to get to the
end goal! I agree with another person who posted. I think some doctors
take advantage of the fact that this surgery is much needed by many and
that we are so excited to get it that they justify charging patients the
associated fees. Oh well. We do what we have to do! Good luck!
— B. Jones
June 29, 2008
I was fortunate that my WLS surgeon offered all side requirements such as
psych, nutritionist and labs in his office. It was one of the reasons I
went with him. They had already done the leg work for their most popular
accepted insurance patients and let me know right up front what each would
cost. If your doctor's office manager cannot or will not offer you a
better answer to why the charges are more, shop around or call your
insurance company yourself and ask about your coverage. Doctors offices
usually call the insurance company to find what they will pay for a
specific service. If they are padding it you should question their
practices. There are great doctors out there who might better serve your
physical and financial needs. Take the time to reevaluate your situation.
You must be able to trust your physician on all levels to have the most
success. If you always feel taken advantage of, you are not in control of
your own destiny. Don't get desperate!
— texast
June 29, 2008
I had to pay for my psych evaluation out of pocket. I think it was $200 or
$250. I also had to pay for the nutrition class out of pocket, which was
$200. Everything else was covered 100% by my insurance, including the
sleep study I had done. The only other expense I had was the initial copay
to the surgeon, plus gas to and from the hospital, which is 40 minutes
away. I think your psych evaluation charge is a little exorbitant. I'm
not sure why the WLS surgeon would charge money up front for those who had
to pay that, but I can see that more than I can the $500 for the psych
evaluation.
— ALafferty
June 30, 2008
I'm in NYS and thankfully I did not have to pay anything upfront. Only
costs I have associated with the surgery are the normal co-pays: $25 for
the pysch evaluation, and $25 for each nutritional appointment (3 appts.).
Even my fills are covered.
My advice is to contact your insurance office and find out exactly what
they cover. Another option is to find a surgeon in your area that accepts
your insurance and doesn't charge any upfront costs.
— Monte57
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