Question:
I just spoke with Dr. John Alexanders officemanager. My insurance pays 100%

She said I would still have to pay $1,000.00 because insurance only pays 100% of approved customary charges? DA..that's how insurance works. I had heard very good thing about Dr. Alexander until this point but now I am a little leary. This sounds like it may be illegal. Any advise.    — [Anonymous] (posted on January 16, 2002)

January 16, 2002
I am guessing you are talking about Dr. Alexander in Dallas? His office does that with everyone now! I don't know why either, what part of 100% don't they understand? They told me I would have to come up with the money 8 days before surgery. Talk about stress. Email me if you have any other questions.
   — Kendra A.

January 16, 2002
Your doctor only gets paid what the insurance company feels is resonable and customary. If he participates with your insurance, then he must take what they pay...if not, he can balance bill you for any portion they dont pay. For instance, if he charges $5000 for the surgery and your insurance companie's allowable is $3500, you would still owe $1500. You can find out what the dr charges and then check with you insurance to see if his fees are within their allowable. They wont tell you exactly what their allowable is, but they will tell you if your dr's fees are within their limits. Hope this helps.
   — Renee D.

January 16, 2002
The last poster was correct. If your surgeon participates with your insurance, he has to take what they pay. That's the agreement. However, if he isn't participating, then you probably do have to pay the difference between what the insurance allows and what he 'normally' charges. I would be really suspicious of someone who waited until after you have things set up to let you know about the cost. If you're not sure whether he's a participating provider or not, call your insurance company to confirm. If he is participating, let them know that he's trying to get you to pay more.
   — [Anonymous]

January 16, 2002
To the person who originally asked the question. If you talk to your insurance, would you please let us know what they told you? This is probably the 9th or 10th time I've seen someone report something similar. Just curious.
   — [Anonymous]

January 16, 2002
The earlier poster was correct. If Dr. Alexander is in your health insurance network, he MUST accept their payment and not charge you anything else. If he's not in your network, try to find a doctor who is. I can offer you a suggestion if you will email me at [email protected]. I know that Dr. Alexander wasn't on my insurance network - he may not be associted with any insurance plans - that seems to the route many of the surgeons in Dallas are going. Patty Butler
   — Patty_Butler