Question:
Doc's office and insurance renegotiations? Anyone ever hear of this???

I spoke with my Doctor's office yesterday and was informed that my approval for surgery my take "a while" because the Doctor's office (Right Weigh program) was in "renegotiations" with Humana over fees/expenses and supposedly all claims have been put on hold by Humana... Has anyone encountered something like this before or is this the office staff's way of brushing me off until they actually hear something?    — Dena C. (posted on August 15, 2002)

August 15, 2002
My Doctors office just went thru this same thing. There was a disagreement on how much the insurance would pay for services. My ins company was wanting to pay less than what Medicare pays (which is close to nothing). Thankfully, in my case they are all on the same page now. But, those things do happen. I dont believe it is a stall tactic.
   — Dawn E.

August 16, 2002
It is entirely possible that your doctor is renegotiating with Humana. I am a Humana employee and I got caught up in the same thing right before my surgery. The hospital that my surgeon usually used decided that Humana was not paying them enough for the surgery, so they said they would no longer allow the procedure to be performed there. I had to wait until Humana was able to negotiate an agreement with another hospital so that my surgeon could perform the procedure there. It took weeks, but at least I got the surgery done and it was covered. It is frustrating, but I don't think they are trying to be deceptive. Doctors and hospitals often renegotiate their fee schedules when they have a change in what they charge or if circumstances warrant it. They want to make money, too. Factors such as how many docs in a certain area perform the procedure and the range of fees charged are monitored by the insurance companies so that they can make sure their members have access to care but can still control the cost somewhat. Despite what most people believe, the insurance companies want to make sure you are able to receive the benefits you are entitled to, but what matters most is which plan your employer chooses to offer. The more benefits they offer, the higher the cost of the plan is. I know I sound like an insurance company public relations person, but I am not. I have seen what goes on behind the scenes to get people the care they need and those folks put in a lot of work.
   — lallen454z