Ok so... to have my surgery I had to pay the cash price for the assisting doctor which was $ 400.00 and was guaranteed that once insurance paid his fee then I would be reimbursed the $ 400.00. So I call my surgeons office today since I knew they had been paid from my insurance company. They proceed to tell me that I owe them money... They couldn't explain why and would call me back tomorrow on that. I owe them the money AFTER keeping my $ 400.00. My insurance paid everything it was supposed to! If they refuse to reimburse me then I'm canceling my follow ups for the rest of the year which should cost them roughly a grand and will follow up with someone else. In the words of Sweet Brown, "Ain't nobody got time for that!!"

That sounds like dirty pool to me. I'm so thankful i have kaiser since its like going to an all inclusive resort. Everything's included and there's no waiting for approval. Wish everybody had it as good as I do. Hope you get it all straightened out.

good for you, don't let them confuse you into just paying and paying. It could be an honest mistake on their part. But, unfortunately some businesses (all kinds of businesses) count on people just taking their word for it that they owe, they count on people not speaking up or asking questions.

If they can't work it out to your satisfaction then "vote with your feet" as they say!

Hmmm ... p!$$ off the surgeon and medical team before the operation ...

Yeah ... good luck with that.

I had everything laid out before I had my date. Pretty common. I have had 3 surgeries since my VSG, and that is pretty standard. I know exactly what I am paying and what insurance is or isn't covering. It's all in writing. Any confusion, show the paperwork.

Did you get an EOB from your insurance company? If not get one. Also get an itemized bill from the Doctor. If you feel like they are scamming you, let your insurance company know. It is against their contract to balance bill or any other shenanigans

Good luck.

Hmmm ... p!$$ off the surgeon and medical team before the operation ...

Yeah ... good luck with that.

It looks like he already had his surgery on 12/31. . .

It looks like he already had his surgery on 12/31. . .

Was that in his signature? Don't have them turned on.

If that's the case, give 'em H3LL

Hmmm ... p!$$ off the surgeon and medical team before the operation ...

Yeah ... good luck with that.

... I'm POST surgery... and they're pulling this crap now after I forked over the money with a promise I'd get it back after surgery. That's why I'm upset.

Did you pay cash? Or with a card? Perhaps your bank can get in on this fight

The 400 was with a card now that you mention it. I wonder if I can reverse charges?

In the words of Sweet Brown' date=' "Ain't nobody got time for that!!"[/quote']

Lmaooo! I'm sorry but I busted out when I saw that! I love that lady haha..

2nd so sorry your gotta fight with them. That's BS! You would have thought they would have told you this before surgery! Hope you get it worked out and don't forget to check your out of pocket max. If you have met that you won't have to pay anything the rest of the year. Your insurance will pick everything up. (That's what my dr said so who knows lol)

@DayByDay what is a EOB? I haven't had surgery yet, I am waiting for approval from Ins. I have a high deductible so a lot of it will be coming out of my pocket. Any tips of what I need to have that you can share would be great. Thanks in advance :}

I'm not an expert at this but have had my share of experience with insurance companies. The more information you know the better off you are.

EOB is an explanation of benefits. It explains what the doctor is paid, what the plan pays, and what the patient pays. I would get one from the insurance company, if not ask. I would also ask the doctor for an itemized bill. Also, if you stay at a hospital you can ask for an itemized bill. Depending on how it is all lumped together you may want one from the anesthesiologist as well.

What you would want to try and do is match all your doctor bills against the EOB to make sure you are not being billed for some random charge. If you do, you can call your insurance company and question it, see if they pay it, why they wont. Many facilities are becoming like banks by charging you random fees. Like a facility fee. Meaning just for seeing a doctor in facility you pay a fee. It can be as much as $100. Some insurance companies do not pay that fee, some do. Anyway, depending on your insurance and how cooperative or helpful they are, you can always see if you can have an idea of what your costs are before your surgery, so you can be prepared.

Anyway, just some ideas. I hope this is helpful. Take care and good luck.

The 400 was with a card now that you mention it. I wonder if I can reverse charges?

If you explain the situation to a banker, they should be able to help you. You put down a deposit pretty much and now they won't give it back and are changing their story. Your bank can investigate and all that on your behalf.

So after talking to the lady in the insurance billing at the surgeons office - she basically said they are holding the $ 400.00 because the insurance company has never approved as much as they did for the assistant for me. I told her flat out my policy ALLOWS 25% of the surgeons billable rate which is actually MORE than they billed for him. She was all like "so if we refunded the money and then the insurance company comes back at the end of the year on an audit and voids the payment because they overpaid will you pay for it?" - I said I can't pay 1100 at once but I would monthly. So yeah... they're holding it hostage b/c my insurance company paid. WTF.

I would send a firmly worded letter that per your agreement, the $400 was refundable. If they misbilled the insurance company that is a separate issue that they need to resolve with the insurance company, and since your deductable and coinsurance (if applicable) are paid in full, you will be looking for a check from them within 2 weeks otherwise you will bring the issue to the attention of your state's Attorney General office.

Also, this sounds like backward balance billing...which is illegal in most states if you are using in network providers.