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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