Question:
Just got approval but told I have to prepay my portion on day of surgery.
Has anyone heard of this or had to do this?? Seems a little unreasonable to me -- I'm sure it will be in the thousands, I don't know if I can come up with it? Anyone experience this or have any advice? — beeda (posted on April 7, 2003)
April 7, 2003
Take a deep one and calm down hon! I too have a percentage that is due at
surgery, however, I also have a "out of pocket max," my out of
pocket is 3000 per year plus my 500 deductible. The insurance will receive
my hospital bill first since it is pre-pay. That will take most of my out
of pocket max, so I made a loan with them at 18%, but hey, I only have to
come up with $76 the day before surgery for the hospital. My surgeon's fee
is $356, which they agreed to let me pay half after surgery. Just be sure
to make plenty of phone calls, explain the situation, ask about hospital
loan programs, etc. Feel free to e-mail me. :)
— Sylvia E.
April 7, 2003
I don't know how your Blue Cross/Blue Shield PPO works, but for the Aetna
USHC HMO I have, all the patient is required to pay is the co-pay. The
doctor or hospital, both of whom were contacted with Aetna USHC, couldn't
ask for prepayment of any amounts and had to accept the contracted amount
that Aetna USHC paid.
<p>
Is it the insurance company or the doctor/hospital that is telling you that
you have to prepay? If it's the doctor/hospital, I would talk to your
insurance company (there should be a telephone number for Member Services
on your card) and ask them if such a request for prepayment is allowed.
If it is not - and the surgeon and hospital is contracted with your BC/BS
PPO - then I'd go back to whoever told you to prepy and give them the
information from the insurance company.
<p>
Make sure that you get names of everybody that you talk to at the insurance
company as well as at the surgeon's office and/or the hospital...JR
— John Rushton
April 7, 2003
Yes, my portion is $1,500.00 because the doc is not in our PPO, and
$1,000.00 has to be paid before the surgery is done.
— Rita M.
April 7, 2003
Doctors and Hospitals do have the right to bill you upfront for your
portion. However, they may try and base it off of the charge, not the
allowance. Please make sure you ask "what is your portion, based on
the allowed amount?"
— Sharon H.
April 7, 2003
Sharon - that may be the case with indemnity plans, but with HMO's, all
that the doctor and hospital can collect beforehand is their copay (in my
case, $10 copay for the surgeon and $0 copay for an inpatient hospital
stay). They cannot collect a prepayment and reimburse you when the HMO
pays them - that is a violation of their contract with the HMO. You know,
there are a lot of people that run down HMO's, but their coverage has been
fantastic for me. Outside the RNY, I was hospitalized 6 times during an
18-month period (6 times for leg infections and one time for blood clots in
both lungs). The only money I had to pay out during any of those hospital
visits was for the telephone and TV. The only money I had to lay out for
my RNY was my initial $10 copay for the surgeon, $200 for the nutritional
consult, $200 for the psych consult and my telephone and TV during my
hospital stay. Certainly better than having to come up with thousands of
dollars prior to surgery...JR
— John Rushton
April 7, 2003
<font color="007000" face="tempus sans itc">I was
told by my surgeon's office, that the patient portion pre-pay is a policy
(wow, say that 5 times fast)of the Surgeon's office. Check with the office
and see if there is some type of payment arrangement that can me made.
<br> I was lucky enough to change insurance at the beginning of my
journey and picked a policy that paid 100%.
<br>Good Luck! Wendy ~~ lap rny sch'd for April 23, 2003</font
color></font face>
— preop_wendyd
April 9, 2003
Yes I have heard this. Here in Dallas, I was referred originally to a
surgeon who was out of network. While he would file for insurance, he
requested deductibles and coinsurance upfront. Some out of network
hospitals will do the same. However if this surgeon and hospital are
contracting with your insurance, they must follow certain guidelines. Some
contracts allow coinsurance and deductible to be paid up front but the
whole cost of the surgeries is negtioated and you do not have to pay more
than the total allowed amount. When I discovered all of this I decided to
go to another surgeon that was in network. My only payment was $10 to
surgeon and $25 to hospital versus the almost $5000 the other surgeon would
have required. Good luck! Alma (VBG 1/28/03, down 38 lbs).
— Alma W.
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