Really Upset..insurance Covering 85% Of Lap Band But I Have To Pay 15%

[xavier 153]

I dont want to be the bearer of bad new but maybe since I had to self pay I am bitter...LOL! Seriously for the doc to take what insurance pays and waive the rest is fraud so I wouldnt talk about it here especially if you have links or references to who your doc is! It is illegal for a doc to charge a different amount for different patients so shhhhh!

[Shellyac 22]

Why would that be fraud? The doctor is the one that is losing money, he gets the same from insurance regardless of if he waives the 15% fee or not. It would be fraud if the doctor or the patient lied to the insurance company in order to get the surgery paid.

Plus the doctor isn't charging the patient a different amount, he is just deciding whether on not he chooses to collect on what he is owed.

[loretta\ Baconton Georgia 10]

Have you already been approved by your insurance company for the procedure? It is not an overnight process.. I have been working on mine since April. It was finally submitted to the insurance company on Wednesday, Nov 31. I called today and they still have not put it into the system yet.. I would really shop and make them earn your business.It is not fraud, but standard medical practice to waive fees expecially for those who have insurance but the provider is out of network...

[SkinnyMiniMe 63]

Xavier its not fraud. My insurance told me they don't care if I pay the remainder 20% or the deductible that between the patient and the doctor. He charges the same but he basically takes the 80% that the insurance does pay. Basicaly he is just giving us a discount.

I dont want to be the bearer of bad new but maybe since I had to self pay I am bitter...LOL! Seriously for the doc to take what insurance pays and waive the rest is fraud so I wouldnt talk about it here especially if you have links or references to who your doc is! It is illegal for a doc to charge a different amount for different patients so shhhhh!

[estrickl 1]

My surgery is next Thursday and I actually received a call from the hospital today. I owe 10% and was told by the hospital that if I could pay the entire 10%upfront then I would get a 25% discount off the amount. But, I can't, so I am just giving them $50.00 on the day of registration and waiting for the final bill.

[estrickl 1]

It is not fraud to "write-off" the difference between what he charged and what the insurance paid. I've worked in the medical field for 27 years as an office manager in a private practice and we do it all the time.

[xavier 153]

It is very commonly done but it is fraud. A physician cannot under any circumstances charge one patient a different amount than another for the same procedure for any reason.

[NWgirl 574]

Doctors charge self pay patients different prices than insurance covered patients.

Example: The location I am getting my procedure done at charges $17k for self pay, but upwards of $25-30k for insured patients. So, I'm guessing that the price difference for this particular doctor is like a self pay vs. insured patient. Obviously the people with insurance that covers the procedure will still pay less, but the doctor's take a cut in price for self pay since most people probably can't pull 25-30k out of their finances or finance the balance. I'd love to be charged the self pay price and only pay 20%...