I was approved by Tricare with no problems then the docs office called and told me that he charges $5000.00 for the surgery and insurance only pays $992.00 so he wants me to pay $4008.00????? I am insurance approved and now will not get my band because of this. I just cant believe it:mad2::smile2::mad2::wub::mad2::mad2::mad2::mad2::mad2:

That sucks. I know how you feel. I am still waiting on insurance approval but I think with insurance approval I still have to come up with $3000. Ouch. I don't have that kind of money, especially right before Christmas.

I was approved by Tricare but haven't heard anything about having to pay. I better check into this since my surgery is only 2 weeks away.

According to my insurance Co.............the doc cannot bill me the difference. Its not like I want to argue with the person who is going to open me up, ya know??

Tricare says the doc is wrong but I dont know.

I don't believe that the doctor can bill you the difference in the agreed upon contract amount from the insurance company. He can, however, refuse to accept your insurance and not participate with your insurer, in which case that would make you a self-pay. :smile2:

It is not legal and you can complain to Tricare. If he agreed to accept Tricare, he agreed to their payment schedule and is NOT allowed BY LAW to charge you the difference. Report him. Then find a different surgeon.

I was approved by Tricare with no problems then the docs office called and told me that he charges $5000.00 for the surgery and insurance only pays $992.00 so he wants me to pay $4008.00????? I am insurance approved and now will not get my band because of this. I just cant believe it:mad2::smile2::mad2::wub::mad2::mad2::mad2::mad2::mad2:

I work for one of the major insurance copany medical review units. Is this surgeon a participating physician with the TriCare insurance? If so, he cannot legally balance bill you for what TriCare does not pay as this is the amount he contractually agreed to accept. He can only bill you for co-pays and co-insurance amounts. If is is NOT participating with TriCare Insurance then you will have to cover any difference.

Crystal

I do billing and they are all right..If the doctor is in network with tricare than they have an allowed amount (contracted) with each other!! If he is he can not bill u the difference only copays, deductible and coins...i have personal choice and had to pay 2 things for my surgery 1 was my ded 500.00 and second was coinsurance my total came out to be 1300.00 out of pocket which wasnt bad since they billed 17,000. call ur insurance company and ask them what u will be liable for.

Tricare says he is a network physician and cannot bal bill me but the doc office said she can because they are not contracted for bariatric surgery, tricare says they cant pick so I am waiting review. They did however say he may be submitting under a different tax ID # and then they can get away with balance billing

I was approved by Tri-care and have already had my surgery. I haven't had a problem with it. Have you called Tri-Care and talked to them?

Yes, I have and they are having a Patient Representative contact the doctors office. Not sure I want to go back if I think they are mad at me and he is the only one in town.

He won't dare harm you. His malpractice insurance would go through the roof! They'll probably give you extra special care so you don't come back to haunt them!

If he is the ONLY tricare bariatric surgeon in town, can you go to another town and get the surgery?

They are all correct; he is actually trying to steal from you.

If you're not comfortable with him see if there is someone in a town that you could drive to. I doubt though that he would mess himself up by possibly getting sued for malpractice. So I'm sure you have nothing to worry about.

It stinks because until today I really liked him. Am I crazy for thinking it may all be a mixup on there part?

You'd think that he would know about Tricare. In order to be part of a PPO you accept that what they pay you is what you get. Even I know that and I'm not a surgeon. It's his income; I'd bet dollars to donuts (ok make that protein shakes LOL) that he knows. He is just trying to get more $$ out of you. Sorry, but that's how I see it.