So I was speaking with the coordinator at the surgeon's office and I was told that I need to pay my deductible, out of pocket amount, then 20% of the procedure (insurance would pay 80%) along with a $675 program fee. All of this is due at my pre-op appointment on Aug.30th and once this is paid, she will then submit to BCBS to see if it is approved. I forgot to say that all of this is non-refundable and they can't guarantee an approval from the insurance company. I'm trying to figure out if this is a common practice among surgeons everywhere. I really can't afford to give up all that money for it to be denied. Then what?? I'm also trying to figure out how in the world they're making me pay 20% up front if they don't know what the insurance company is going to allow them to charge. She also said that if approved, once the surgery is over with and the insurance sends them their claim, they will refund me me via check in the mail whatever amount I overpaid.

I don't know whether it is common or not. My surgeon required $495 after the first appointment to cover the binder of information they gave me and administrative expenses until my insurance approved the surgery. I was not required to pay anything else up front. BCBS federal is my insurance and my copay was $100. I paid that after the surgery.

So I was speaking with the coordinator at the surgeon's office and I was told that I need to pay my deductible, out of pocket amount, then 20% of the procedure (insurance would pay 80%) along with a $675 program fee. All of this is due at my pre-op appointment on Aug.30th and once this is paid, she will then submit to BCBS to see if it is approved. I forgot to say that all of this is non-refundable and they can't guarantee an approval from the insurance company. I'm trying to figure out if this is a common practice among surgeons everywhere. I really can't afford to give up all that money for it to be denied. Then what?? I'm also trying to figure out how in the world they're making me pay 20% up front if they don't know what the insurance company is going to allow them to charge. She also said that if approved, once the surgery is over with and the insurance sends them their claim, they will refund me me via check in the mail whatever amount I overpaid.

For me it look like this practice is out of network on your insurance and you have 80/20% coverage out of network.

this is why you need to pay deductible (only if you didn't pay that before this year) and you need to pay them 20%.

Call your insurance and ask if this Doctor and hospital in network with your insurance.

I was to pay any co pay 2 weeks prier to surgery, but with my insurance it was 100% covered. I think its weird they would require so much up front and NO refund. I would check into it, also call around see if there is another place. To pay all that out of pocket and then no surgery, that is a ripe off.

So I was speaking with the coordinator at the surgeon's office and I was told that I need to pay my deductible' date=' out of pocket amount, then 20% of the procedure (insurance would pay 80%) along with a 675 program fee. All of this is due at my pre-op appointment on Aug.30th and once this is paid, she will then submit to BCBS to see if it is approved. I forgot to say that all of this is non-refundable and they can't guarantee an approval from the insurance company. I'm trying to figure out if this is a common practice among surgeons everywhere. I really can't afford to give up all that money for it to be denied. Then what?? I'm also trying to figure out how in the world they're making me pay 20% up front if they don't know what the insurance company is going to allow them to charge. She also said that if approved, once the surgery is over with and the insurance sends them their claim, they will refund me me via check in the mail whatever amount I overpaid.[/quote']

So let me get this straight. Let's say the surgery is $15K. They want you to put up $3675, and if you get denied they return none of it? I really hope hat you are having a breakdown in comunication with them or I'm misunderstanding.

I think if this were put to me I would offer to put the money into escrow for release upon approval.

No...that is not common practice. That would definitely cause me to go to a different specialist.

I have bcbs and I didn't do any of that. I only paid my copays and didn't have to pay any kind of program fee... Nor did I have to pay anything up front

The total amount that I was told to bring on Aug.30th was $6975. I asked them to explain to me the fees and she provided me with a breakdown.

Their breakdown: Surgery is $22000

20% of 22000 = $4400

$675 Program Fee

$500 deductible

$1900-$500= $1400 (out of pocket expense)

With that much down to pay, I might as well go to Mexico and make a vacation out of it. My husband doesn't want me to do that though

I had to pay $600.00 out of pocket. First $200.00 was due the third month for all the Group meetings that I can go to including a Christmas Party every year. The Group meetings have Psychologists, recipes, clothing exchanges and different subject once a month. This is for life. The 2nd $200.00 was to pay for the nutritionist. This includes Free Nurse Appointments, once a month weigh ins, and nutritionist....for life. The 3rd $200.00 was to pay for the 14 day supply of shakes for the preop time. I haven't received a bill since then, from the hospital or the doctor's yet and I'm almost 3 months out. I have bcbsil 90/10.

Also, my room was a big private room almost like a hotel and I spent 5 days in the hospital.

Each $200.00 was due during different times. I was approved before the last $200.00 was due.

When I went for my consult a couple of weeks I guess I signed a paper agreeing to this non-refundable policy. I honestly didn't remember signing it but they faxed me over a copy with my signature on it.

Your doctor is a crook. Find another one.

My insurance company (Multi-plan) requires me to pay a personal deductable of $350 per year. I met that prior to surgery, so I was then responsible for 15% of my surgery. I paid $180 out of pocket to see a Nutritionist (2 visits) and to get my Psychological eval. I could have gone anywhere I wanted, but it was just easier for me to do everything with them. My surgery included a hernia repair (which I didn't know about until I was in recovery) cost me $460. Not too bad! Then I got annoying bills. When I was allowed to be released, my Surgeon was going to be in Surgery for the rest of the day. They had a PA come in and ask me a couple of questions. The PA signed me out. I got a bill of $100 for their service. They spent 5 minutes with me. I got the Anesthesiology bill, the hospital bill and the radiology bill. I think all together, I had to pay close to $2,000. I wasn't asked to pay any Doctor fees upfront. My Surgeon has support group 3x a week that I can go to for life at no charge. In fact, they encourage me to go. They do the clothes swap as a free service.

I work at a hospital and I can tell you it is not ethical for them to bill you I advance for the 20% of charges, because what they bill your insurance (charges billed) is not what the insurance pays. It is customary to charge the deductible and copay prior to the procedure, but not the rest. And the deduct able and copay should not be paid until you have your date and your closing in on the procedure.

If I was in your shoes, I would call your insurance company and discuss the issue with them. I know that I can't bill an insurance company for services I provided if i haven't provided the services yet. It's highly unethical. This might be a great time to look into a different surgeon's office that are more ethical. I know that it is hard because you don't want to waste any more time. But I would hate to lose my money if insurance denies coverage. The insurance company can tell you the guidelines for acceptance. It's ok to be proactive. Please let us know what you decide and how it goes.

Like everyone else has said, "Call your insurance company!!!!" The cost of $22,000 may not be the contracted price agreed upon by your insurance company and your surgeon. You're responsible for 20% of the contracted price. Your insurance can tell you how much you've met of your deductible, OOP, and what 20% of the contracted price is. Unfortunately, there's no way to get past that binder fee, those things aren't usually covered under insurance, but may still be tax deductible. Good Luck!

Do you have coinsurance? Maybe something to look into.

I have co insurance which means other than my deductible. I can only pay 1500 per year out of pocket. I have Premera BCBS. My deductible is met and part of my 1500.

I have never heard of these other fees.

Best,

Sannah

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