Question:
Is it legal for the surgeon to keep my deposit once he accepts Aetna HMO?

My surgeon sent papers today that mentions a required $750 deposit. I can understand his wanting to make sure he gets something for his services, in case Aetna refused at the last second, but once he receives the money from Aetna, isn't he obligated to take whatever they pay under contract? The paper says my deposit will "be applied to the balance of account after insurance pays. We will refund any overpayment." What does this mean? I had five surgeries since 1999, and the only thing I paid was my $15 copay. Could someone reply that's familiar with the law on this? I feel this is wrong, but there aren't any other surgeons on Aetna's plan locally. Thanks.    — Amy K. (posted on February 9, 2001)

February 9, 2001
That sounds strange to me. I would think that once they apply for insurance approval and get it, the only thing you should have to pay is your copay. I would hate to think that you would have to sit around and wait for them to decide to reimburse your money. Is there another dr in your area? Maybe you can check into this. Good luck Tanya
   — Tanya P.

February 9, 2001
I have Aetna and understand that the physician should not ask for additional funds if that surgeon is in network. I would seek advice from Aetna and perhaps seek another surgeon with better ethics. You should not have to pay anything outside of your agreed upon co-pay.
   — corpdiva2006

February 9, 2001
Thanks ya'll! I called Aetna, and they said he's within his rights to charge any extra. That sucks, huh? Anyway, I asked them to give me the name of another in network doctor. I called his office and asked ahead of time about any additional deposits. They said NONE, so I'm getting a new referral to this guy. He's also much younger, with less of a reputation for mistakes and complications, so I feel better anyway. :)
   — Amy K.

February 9, 2001
I'm not positive, but I'm pretty sure this is illegal, or at least immoral. Definitely tell Aetna about this, and if you don't get any satisfaction, then call your state insurance commission. None of the doctors like HMO's but, as you said, they have signed contracts with them. Please let us know what happens, this subject will probably come up again and may help someone in the future. Love, Leslie
   — Leslie F.