Question:
What should I do.....
It's me again....I am debating on finding another surgeon. My ins. co. tells me that the Surgeon's office is legally bound to pay the discounts because they have a contract and are in their network. However Kelli at the surgeons office handles all the ins. stuff and she said that they DO NOT pay the discounts and she doesnt know ANY surgeon that does!! I don't know if I should fight this because he is a wonderful surgeon (from what I understand) or should I just give up now while I am ahead. I mean if I go to another surgeon are they gonna say the same thing? I am getting so upset about the Whole situation. — Sabrina Plunkett (posted on July 28, 2003)
July 28, 2003
If yor surgeon is contracted with your insurance plan, than YES, they are
obligated to take the discount and CANNOT bill you for it - that is illegal
(to bill you for the discount).
— Barbara C.
July 28, 2003
I don't know your situation but my hospital and surgeon contracted with the
ins to pay only a certain amount and all over that was discounted (wrote
off). I have had to pay nothing and am not responsible for that amount.
— Delores S.
July 28, 2003
No one pays the discounts...they are just written off. And MANY surgeons
do this. Give her the name of mine...lol..he did. Talk with your insurer,
issue a complaint about the doc...not that you are really complaining, but
the provider rep will call kelli and remind them of thier contract. A
polite way of saying...ummm hey, whats up here.
— RebeccaP
July 29, 2003
What everyone has said is true. The surgeon cannot "opt-out" of a
contract. You are not responsible for the difference between the contract
amount and the amount the surgeon is asking for payment. I went thru this
before with a couple of doctors while I was trying to have the surgery do.
I also filed a complaint. What it is is that the Dr isn't satisified w/the
amout they are being paid and want YOU to come out of pocket for the
difference. One doc wanted 3K up front and the other wanted 7K up front.
There are some more scrupulous <sp> doc's out there. Try looking on
this site for other doctors close to you and try emailing the member's here
that have the same insurance as you and that way you can get a feel for how
the doc functions (does he charge up front or not) then call and start
making appt's. Too many ppl are trying to cash in on this surgery and there
are too many ppl desperate to have it, so they pay the up front costs - no
matter what. Robin 7/2/03 390/360/175
— Robin J.
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