Question:
Has anyone ever ran across this reimbursement situation....??????

In your opinions does anyone find it unreasonable and unethnical that your surgeons office will not provide you with a bill statement when you pre-pay,even though your insurance company has now agreed to reimburse you surgeon's fee because they would feel "cheated" out of the "discount" given for self-paying???? If anyone has had this happen please give information on it.....    — monique W. (posted on July 24, 2001)

July 24, 2001
Your question is hard to understand. You mention "pre-pay" which tells me you pay before the actual surgery. It would be hard for a surgeon to give you an itemized statement before you have surgery. I think they can give you an estimate. If you have surgery and he/she will still not provide you with an itemized statement then I think something is wrong.
   — Elizabeth C.

July 24, 2001
Some Drs give self pay patients a break, I've heard up to 40%. They do this to help self pays get the surgery and waive some of the usual fees. If, after the surgery, you are finding out your insurance is paying for the surgery, the Dr will want 100% of what he usually charges. I don't think that's sneaky or unfair, if the ins is paying you no longer need the cash discount. I think this is what you are talking about.
   — Becky K.

July 24, 2001
Tell me if I have this right - I'm preop but I have had a similar incident with glassess. I took my son to the optomatrist to have glasses. I had a new job and didn't know I had optical so I prepaid the entire amount. The next day I found out I had optical and went to the doctors office to submit my insurance and thought I would be getting all the money I paid back and then they would submit the claim to the insurance company. BUT The way they figured it up, after taking away my selfpay discount, that the amount I paid would somehow be my co-pay (which by contract was only 10.00for exam and 20.00 for frames) But I paid over 200.00. I argued and argued with them, even went into the office and made a big scene ( you can tell I was mad and haven't forgotten about it either) I called my insurance company and told them what they did. Nothing helped. They would not give me my money back. I have never went back, and anyone who knows me knows not to mention their name around me. Is this similar to what you are talking about happened to you?
   — K T.

July 24, 2001
My guess is the surgeon is reluctant to give you a bill/statement for the surgery because he hasn't performed the procedure yet. Granted he knows the charge for a standard, uncomplicated procedure. But, what if there are complications that require more more extensive work...if you have a statement from him that could be construed as payment in full and he wouldn't be fairly compensated for any additional time/ work. Physicians have to protect their own financial interests.. this is their business. Why don't you ask for a receipt for for a "deposit" on your surgery. After the surgery, the surgeon's office should then give you a true bill. less the deposit that you pre-paid. it certainly has nothing to do with being "cheated" out of a "discount".
   — [Anonymous]