Jump to content
×
Are you looking for the BariatricPal Store? Go now!

So pissed...



Recommended Posts

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.

Share this post


Link to post
Share on other sites

DO NOT agree to pay anything above and beyond your deductible and coinsurance or copay. That is balance billing and it is illegal almost everywhere unless you are out of network...and then they can only balance bill you for the difference between what the insurance paid and what they normally would pay (example if they normally pay 80% but only pay 60% out of network, they could bill you for.hour normal 20% plus the 20% difference).

Share this post


Link to post
Share on other sites

They are in network.

Share this post


Link to post
Share on other sites

Then they need to bill insurance correctly and refund you your $400 per your agreement.

And actually, in your state, you would complain to the medical board. There is information in this document about balance billing in your state (and it specifies that it is for out of network providers/facilities only) with links at the bottom who to complain to.

http://www.tdi.texas.gov/consumer/cpmbalancebilling.html

Share this post


Link to post
Share on other sites

I sent the person over this the following email - think it will work?

--------------

XXXX,

I paid Dr. L's cash pay price as a DEPOSIT which was guaranteed to be refunded after insurance paid. I did more research and it appears that what you guys are doing now is balance billing by holding the $ 400.00 hostage. This is not allowable as both Dr. L and Dr. P are in-network providers as verified with my insurance plan. I will expect the $ 400.00 to be refunded asap. If Dr. P does not allow the refund after you speak with her on Monday, then I will contact the Texas Medical Board and United Healthcare. I'm not trying to get nasty, but I do expect you guys to uphold your end of the agreement. I don't have an excess of money and borrowed the $ 400.00 on good faith that it would be reimbursed as promised once insurance paid - and they have.

Share this post


Link to post
Share on other sites

Agree with Mizzz...it's def a good starting point. I hope they do the right thing and refund you right away. But if not, you've got your ducks in a row to start a complaint.

Share this post


Link to post
Share on other sites

If they don't refund, sick your bank on them. Call the fraud department and have them investigate

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • LeighaTR

      I am new here today... and only two weeks out from my sleeve surgery on the 23rd. I am amazed I have kept my calories down to 467 today so far... that leaves me almost 750 left for dinner and maybe a snack. This is going to be tough for two weeks... but I have to believe I can do it!
      · 0 replies
      1. This update has no replies.
    • Doughgurl

      Hey everyone. I'm new here so I thought I should introduce myself. I am 53y/o and am scheduled for Gastric Bypass on June 25th, 2025. I'm located in San Antonio, Texas. I will be having my surgery in Tiajuana Mexico. I've wanted this for years, but I always had insurance where bariatric procedures were excluded. Finally I am able to afford to pay out of pocket.  I can't wait to get started, and I hope I'm prepared for the initial period of "hell". I know what I have signed up for, but I'm sure the good to come will out way the temporary period of discomfort and feelings of regret. I'd love to find people to talk to who have been through the same procedure or experience before. So I look forward to meeting you all. Hope you have a great week!
      · 0 replies
      1. This update has no replies.
    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. LeighaTR

        I hope your surgery on Wednesday goes well. You will be able to do all sorts of new things as you find your new normal after surgery. I don't know this from experience yet, but I am seeing a lot of positive things from people who have had it done. Best of luck!

    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

    • CaseyP1011

      Officially here for a long time, not just a good time💪
      · 0 replies
      1. This update has no replies.
  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×