Question:
Is anyone having problems w/insurance not paying for intial consult with surgeon.
My surgeon has ask for his fee upfront because BCBS is not paying for the first visit. It would seem that if they approve the surgery and then file. BCBS might pay. Anyone else having this problem. I personal thought that I would only be paying the co-pay. — mickie5535 (posted on May 12, 2002)
May 12, 2002
Mickie, my doctor also asks for payment upfront for the first visit.
$250.00 That's with or without insurance. My insurance co. is Cigna PPO.
Also we have to pay $45.00 to the psychiatrist and $45.00 to the
nutritionist. They don't accept insurance. Then two weeks before my
surgery, if I get approved, I have to pay $4500.00!!!!!!!!!!!! I will get
80% of that back. They say that is because they have had insurance
companies approve and say they will pay and then they don't. So I guess
that's a surgeon's fee.To me, what's the point of having the insurance if
you're not going to accept the co-pay?
— angela D.
May 12, 2002
Call your insurance company and ask them about it. If your doctor is
in-network, he/she has an agreement with the insurance about who pays,
what, and when. It may be OK for the doctor to ask for that fee up front,
but it may not be. I think I've seen an awful lot of folks who had doctors
ask for money when they weren't allowed to. If your doctor is
out-of-network, then it's a different thing altogether, since they don't
have to accept your insurance at all if they are not contracted with the
insurance. company.
— garw
May 12, 2002
Angela, I'd give you the same advice. If your doctor is in-network, call
the insurance company and find out whether it's within his contract rights
to ask for that much up front. If he/she is out of network, then they can
probably get away with it.
— garw
May 13, 2002
I just got a call from my doctors office about my insurance refusing to pay
for my 1st visit. They paid for my surgery with no problem, I don't get
it. I will call them and find out what is going on. I'll let you know if
I find a way to make them pay it.
— Alison N.
May 13, 2002
This is fairly common for BCBS. I had this problem. If there is no
exclusion for this surgery in your contract what you will need to do is pay
for the first visit when you surgery is approved appeal for the consult and
then they will pay. However you might have problems w/ follow up. Every
visit I made to my surgeons office was denied and I had to appeal each
visit. It became a long and drawn out process. However, I am 7 mo out and
down 130 lbs so it was worth the hassle. I have BCBS of MD as I work for
GEICO. This may make a difference.
— Jennifer H.
May 13, 2002
Hi...I am also having the same problem. My doctor is in the network, but
when they submitted the paperwork to the insurance company, they listed it
as obesity. My insurance company covers the surgery, based on medical
necessity, but they do not cover anything else for the treatment of obesity
or weight control. That's why they are not covering the consult for me. I
am not sure, if once they approve the surgery, that they will also pay for
the consult. My surgeon's office did tell me though that there are
insurance companies that don't (whether its before or after) pay for the
consult (even if they do cover the insurance). Have you tried calling your
insurance company to find out? That's what I did because I couldn't
understand why it would not be covered if I willingly went to see him for a
consultation, not to receive any type of treatment, but that's what they
told me. Doesn't make much sense to me, but I am not making much of it now
until I find out about my approval. Good luck to you!
— Giovanna G.
May 13, 2002
Hi - I had the same issue with my insurance company. What I did was call
and by-passed (no pun intended)the customer service team and asked to speak
to someone on the "medical review" team for my case. The
question I posed to her was "How am I suppose to know if I meet the
criteria ofr surgery if I don't go for a consultation." It was
covered within 10 minutes after our phone conversation. Always advocate
for yourself. They will always kick out the first claim!! Good luck!!
— Carrie B.
May 13, 2002
I also have bc/bs and they refused to pay for the initial visit of 231.00
and my dr. is a bc/bs dr. I had to pay for this fee up front befor I could
go to my pre-op apt. which was approved. I also had to pay for the pre-op
apt. (l43.00) up front befor they would do my pre-op tests and make my
surgery date. I dont know if I will get this back or if Ill have to pay
for all my post-op apts too.
— Rita P.
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