Question:
Is anyone having problems w/insurance not paying for intial consult with surgeon.

My surgeon has ask for his fee upfront because BCBS is not paying for the first visit. It would seem that if they approve the surgery and then file. BCBS might pay. Anyone else having this problem. I personal thought that I would only be paying the co-pay.    — mickie5535 (posted on May 12, 2002)

May 12, 2002
Mickie, my doctor also asks for payment upfront for the first visit. $250.00 That's with or without insurance. My insurance co. is Cigna PPO. Also we have to pay $45.00 to the psychiatrist and $45.00 to the nutritionist. They don't accept insurance. Then two weeks before my surgery, if I get approved, I have to pay $4500.00!!!!!!!!!!!! I will get 80% of that back. They say that is because they have had insurance companies approve and say they will pay and then they don't. So I guess that's a surgeon's fee.To me, what's the point of having the insurance if you're not going to accept the co-pay?
   — angela D.

May 12, 2002
Call your insurance company and ask them about it. If your doctor is in-network, he/she has an agreement with the insurance about who pays, what, and when. It may be OK for the doctor to ask for that fee up front, but it may not be. I think I've seen an awful lot of folks who had doctors ask for money when they weren't allowed to. If your doctor is out-of-network, then it's a different thing altogether, since they don't have to accept your insurance at all if they are not contracted with the insurance. company.
   — garw

May 12, 2002
Angela, I'd give you the same advice. If your doctor is in-network, call the insurance company and find out whether it's within his contract rights to ask for that much up front. If he/she is out of network, then they can probably get away with it.
   — garw

May 13, 2002
I just got a call from my doctors office about my insurance refusing to pay for my 1st visit. They paid for my surgery with no problem, I don't get it. I will call them and find out what is going on. I'll let you know if I find a way to make them pay it.
   — Alison N.

May 13, 2002
This is fairly common for BCBS. I had this problem. If there is no exclusion for this surgery in your contract what you will need to do is pay for the first visit when you surgery is approved appeal for the consult and then they will pay. However you might have problems w/ follow up. Every visit I made to my surgeons office was denied and I had to appeal each visit. It became a long and drawn out process. However, I am 7 mo out and down 130 lbs so it was worth the hassle. I have BCBS of MD as I work for GEICO. This may make a difference.
   — Jennifer H.

May 13, 2002
Hi...I am also having the same problem. My doctor is in the network, but when they submitted the paperwork to the insurance company, they listed it as obesity. My insurance company covers the surgery, based on medical necessity, but they do not cover anything else for the treatment of obesity or weight control. That's why they are not covering the consult for me. I am not sure, if once they approve the surgery, that they will also pay for the consult. My surgeon's office did tell me though that there are insurance companies that don't (whether its before or after) pay for the consult (even if they do cover the insurance). Have you tried calling your insurance company to find out? That's what I did because I couldn't understand why it would not be covered if I willingly went to see him for a consultation, not to receive any type of treatment, but that's what they told me. Doesn't make much sense to me, but I am not making much of it now until I find out about my approval. Good luck to you!
   — Giovanna G.

May 13, 2002
Hi - I had the same issue with my insurance company. What I did was call and by-passed (no pun intended)the customer service team and asked to speak to someone on the "medical review" team for my case. The question I posed to her was "How am I suppose to know if I meet the criteria ofr surgery if I don't go for a consultation." It was covered within 10 minutes after our phone conversation. Always advocate for yourself. They will always kick out the first claim!! Good luck!!
   — Carrie B.

May 13, 2002
I also have bc/bs and they refused to pay for the initial visit of 231.00 and my dr. is a bc/bs dr. I had to pay for this fee up front befor I could go to my pre-op apt. which was approved. I also had to pay for the pre-op apt. (l43.00) up front befor they would do my pre-op tests and make my surgery date. I dont know if I will get this back or if Ill have to pay for all my post-op apts too.
   — Rita P.