so, i was approved by Aetna to have the lapband surgery. spent alot of money out of pocket, drove 100 miles to surgeon, did everything on the list. so, i get a call from the surgery coordinator . i am thinking she is going to give me my Pre Op appt. WRONG. she told me that the surgeon may refuse to do my surgery because AETNA is not paying him enough. can you believe that? He is actually thinking of backing out on me for 1200.00. that is what the difference is in his standard pay for the surgery and what Aetna will pay him. i will know something tomorrow. has anyone ever heard of such a thing? please reply....... thanks.....:help:

This is actually not that uncommon. My doctors have dropped out of two networks (including Aetna) while I have been their patient. What is questionable is the implication that he can back out of doing YOUR surgery--you should realize that it's got nothing to do with you.

If he is still under contract with Aetna to be a participating provider, he really doesn't have the right to refuse what they pay him for surgeries. If he doesn't like it, he has to change or end that contract, which is fully within his rights.

The difference between what a carrier pays a participating physician and what his "standard" fee is can be substantial, WAY more than $1200. But even so, he is probably contractually prohibited from balance billing you if he is an in-network doctor, so he can't come to you for that money. His only option would be to end his agreement with Aetna.

Insurance sucks, all around.

I went thru something like that too. My surgeon pushed, along with my primary dr and got it done. Aetna is the best insurance in the world........until you need them

Yes, this sounds about right. Sounds like he might be trying to get you to cough up the other $1200 (but that is a guess just by the sudden pressure I felt from reading about the phone call). Don't give up. Post back tomorrow what happens.