Question:
Has any one had to pay doctor approx. $1300.00 befor surgery?
My doctor has requested that I pay 1250.00-1300.00 dollars before he will do surgery. When asked why I was told it covered all the support meetings,doctors visits for 2 years and a few psych. visits. My insurance will cover for any of the supposed visits and all doctors visits. Any one know why this is requested. — [Anonymous] (posted on April 4, 2001)
April 4, 2001
Dr. Afram in DC requires $1250 up front. $1000 is to cover LIFELONG
visits--monthly first year, every three months second year, every six
months third year, and yearly for life. It also covers anything the
insurance won't cover. The extra $250 is for the nutritionist and
psychiatrist. He says that patients won't be responsible for anything over
the $1000 no matter what the insurance pays. In fact, if he does an extra
procedure, such as gall bladder removal, while he's doing the RNY, he will
charge the insurance company, but he'll take whatever they pay and not
request additional funds from the patient.
This sounds like a lot of money, but I wonder how much I might pay out of
pocket after surgery with another physician. I had my spleen out a few
years ago and my parents had to pay almost $3000 for the things the
insurance did not fully cover.
On the other hand, I've heard that some people's insurance covers 100% and
all they pay is a $10 co-pay for doctor's visits. I'd be interested in
hearing what anyone else has to say about this.
— PT LawMom
April 4, 2001
Hi, I had my surgery on 3-30-01 and my insurance covered everything, they
paid for pre-op, office visits, and everything else, but as I sat here and
read your question, I think even if I had to pay 1500.00 or less, I would
definitely jump at it so fast, because overall this procedure will cost
around 25,000, and when you think about it $1200-$1500 is not too bad for
out of pocket expenses, especially since this will change the rest of your
life for the better. If the money is the issue, ask the office if they can
break your payments up in installments...I really hope it will work out for
you, trust me it will be worth it..
Good Luck..
— Ang B.
April 4, 2001
This request seems ok however the reasoning is not. I will have to pay
around 1400 up front but that is because that will cover my deductible and
coinsurance. I would ask for an itemization and the provider should be
informed that you HAVE insurance and will be having them process and pay
these things. I have never heard of a support group getting paid for by a
physician. I attend three different groups here and don't pay a surgeon
for one. I would be wiling to contribute to the group itself if I was
asked to.
— Dawn R.
April 4, 2001
I have to pay $4000 before the surgery so $1250 doesn't sound to bad.
— blank first name B.
April 4, 2001
I am a little confused by this. I had my surgery in January and my hospital
bill was $30,700. Of that I had to pay $1276.00 out of pocket. My Doctors'
bill was for $3000.00 and I paid $275.00 out of pocket. I was never asked
for up front money. I think I would call around and see if other surgeons
in your area are doing the same thing. Good Luck
— marlene R.
April 4, 2001
My surgeon requires a $3,000 payment above and beyond whatever insurance
will cover. It is also described as a program fee to cover the after care,
support groups, etc. The most popular theory I've heard for this type of
fee is to offset the actual cost of the surgery vs. what contracted
insurance pays. - Kate -
— kateseidel
August 31, 2002
I was told I would have to pay $3000 out-of-pocket. I don't know if it's
the insurance or the surgeon. I need help just funding the co-pay. No
payment plan or anything.
— Penny S.
August 31, 2002
My Doctor, Dr. Afram requires $1200 up front. That covers all my co pays
for most of the rest of my visits with him... I would pay $15 per visit
even though my insurance does cover it. Most insurance doesn't cover every
last thing... there is often a co pay. For many doctors, that up front fee
covers what they think they might not get from insurance. I know some
people don't want to pay the upfront fees, or can't but if you can its
worth it.
— Lisa C.
May 10, 2003
The Sacramento area doctors are all out of network for BCBS, and they vary
on up front fees. The best Dr. (in my opinion) requested the entire cost
for surgeon up front (almost $12,000), then he gives you what the insurance
pays. Another local surgeon asks for $3,500 up front, then bills
insurance, and you either owe a little of get a small refund. Out of
network for my plan means I pay $500 deductible and 30%, plus 100% of any
"overage" (when the dr. bills for more than the
"acceptable" rate.)
There is 1 surgeon in the area who is in-network (meaning I pay no
deductible, and 10% up to $1,000 maximum out of pocket), but he charges a
$4000 up front, "weight management" fee, that is not billed to or
covered by insurance. I guess its just a matter of checking around. If I
decide to have the surgery, its going to cost a lot of money, even with my
excellent insurance. Or, I can go out of the area, and pay for airfare,
hotels, etc., and use an in-network dr. somewhere else. I am still
researching options, because I just don't have that kind of cash lying
around!
— Rhonda C.
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