Not Understanding Dr's Fees

mommy2kai · May 29, 2006

I recently went to a info seminar with Dr. Stephen Malley in Overland Park, KS. I have United Health Care, and he is considered an in-network doctor, and I'm in luck because my employer's plan pays for 90% of the cost for LapBand from an in-network dr. Whoohoo!

But....his office charges $150 for the initial consultation, regardless of whether or not you have insurance. My co-pay should only be $20 for an in-network dr. They will submit the claim to my health care provider, and reimburse me the difference of $130. Also, post op visits are $50, if you have a fill they are $100.

So, has anyone else heard of a doctor doing this? If he's part of my health care provider's network, I don't understand why I can't pay my regular co-pay.

Alexandra · May 29, 2006

You're right in that they should accept the copay, but they've probably been burned lots of times by other carriers' deciding not to cover even the initial consultation if the surgery is ultimately declined.

You could refuse, argue, or even report him to the carrier if you want. My gut reaction is that they're just tired of fighting with carriers and this is their way of making sure they get payment. It's not illegal or anything, but probably does go counter to the carrier's rules. So it's up to you to decide if you want to argue with him about it.

If your carrier DOESN'T pay his office visit charge, you'll have to pay it anyway. If they do, the claim should be settled quickly and you'll get your money back. If it were me, and my doctor's office asked me to do this, I'd probably agree because I really wanted them as my doctors.

JMO · May 29, 2006

I also have United and have been told they are great. (not banded yet but filed) You should also ask if your dr has a participation fee. My dr. charges a 500.00 fee that ins. will not pay.. but that pays for all office copays and fees for the first year. So I figured that was worth it. I am in Tn and all 3 of the dr. in this area charge a fee like that. I feel like I am being nickled and dimed to death, psyc exam 150.00 nutritionalist 100.00 deductable 400.00 and drs. part. fee 500.00 but in the end it is better than self pay. I am just happy that I now have an employer that has not had it written out of the policy. You might what to check around and see if that is a trend in your area. Good luck...

JMoe

katt · June 8, 2006

I don't understand it all yet either but try another seminar. Dr. Hitchcock at Bariatric Center of KC is the dr I am using (not banded yet but have cardiology referral next week). I think his fee covers everything. Could be wrong tho. Katt

mommy2kai · June 8, 2006

Thanks for the replies, everyone! Right now, I'm in a holding pattern, because I found out last week that my employer's policy with United does NOT cover any kind of bariatric surgery AT ALL. This, despite me calling UHC on three different occasions and each time giving them the procedure code as well as my group and subscriber numbers. Each time, they told me that our policy covered it at 90% with an in-network doctor. I was going to the seminar with Dr Hitchcock at KC Bariatric, and thanks to the advice of their front office, I contacted my HR to get a copy of the coverage details of our insurance. It was only when I spoke with HR that I was told that our policy doesn't cover bariatrics. Even if I were to have a BMI over 40, and co-morbidities, they will not cover. So right now, I'm stuck. I really want to do this, but self pay isn't an option. I could more easily deal with paying off 10% as opposed to 100%. I kind of don't know what to do next.

JMO · June 15, 2006

I had bcbs in dec when I first checked into the band and it was writen out of my policy too the only way you can get it covered (unless you change jobs) is fight with Hr. One man who worked with my hubby and had it written out of his policy, gave countless reports, dr nots, ectectect. This man has had three heart attacks and one bypass. They paid for all thoses surgeries but would not pay for him to have the lap band... After a year of fighting during open enrollment the Company changed the policy.. It was a long fight but he got the surgery... good luck,,,

TracyinKS · June 30, 2006

I am in the KC area... in the research phase... I am also in HR for my company and I full well know that this is NOT included in our policy...simply because I work for a catholic organization and things like birth control are not even covered let alone elective wls...... it really stinks.... don't fight with HR! Its not their fault, it is the governing entity.. corporate benefit administration committee's

miztrniceguy · July 17, 2006

hmmm.....i'm going to the seminar this sat, and have the same health ins and they told me if approved 90/10 in network.

KarenA · July 17, 2006

I think you should see another Doctor. I'm also UHC, and my doctor takes my co-pay of $15 no matter if I get a fill or not. Also, the initial consultation was $15

See another Doctor.