Do I owe

[imajean]

What is the name of your state (only U.S. law)? Wisconsin.

I went to a bariatric Dr. and was told that if I wasn't a candidate, the visit would be free. I sat and watched a LONG video with 2 other people. When I finally got to see the Dr. His first words were "You are NOT a candidate." I have had 4 surgeries to unblock my legs, and a couple of blood clots. He was also concerned about my age. *57. On top of this, my insurance would ONLY pay after I did a diet with MY dr. and a nutritionist. This information was NOT told to me when I asked if I should contact my insurance company. I was told that it was all taken care of and that they would pay. (Lie of omission?)
But then he asked me questions about what I would say or do IF I was a candidate. He then sent in an insurance person and I told her I WASN'T a candidate. We were both confused, but she continued to tell me about my insurance and I said I couldn't afford 6 months of diet appointments. *my insurance wouldn't pay for the diet) She told me I could go in for something else, like a headache, get weighed and the insurance would pay. I told her flat out I couldn't do that to the insurance co.
After all this, they sent me a bill for $325.00 and are NOW saying that I AM a candidate and the dr. NEVER said I wasn't. I wrote a letter and have talked to the billing office numerous times and they want me to pay.

I swear he said I wasn't and now they are changing their tune and insisting I pay. Help.

 

[Zigner]

Apparently, you ARE a candidate for the surgery. If you wish for your insurance to pay for it, you have to jump through their hoops.

 

[ecmst12]

Your insurance should still cover the consult.

 

[Zigner]

Your insurance should still cover the consult.

OP failed to follow the insurance requirements.

 

[lealea1005]

What is the name of your state (only U.S. law)? Wisconsin.

She told me I could go in for something else, like a headache, get weighed and the insurance would pay

So she implied they were willing to commit insurance fraud and suggested you participate?

 

[imajean]

She did suggest insurance fraud. I was quite upset all around when I left.

I can't afford the diet plan, so was ok I guess that I wasn't a candidate. Then to be told I WAS. I feel I was "made" a candidate when he realized he was losing out on over 300 dollars for the "movie".

 

[lealea1005]

Did you try to send the claim in to your insurance company yourself? As already suggested, the consult may be covered (dependent upon the diagnosis and consult coding).

 

[Zigner]

This doctor is out of network. OP doesn't want to follow the rules for the procedure.

 

[ecmst12]

Where did you get that the doc is out of network? OP hasn't met the conditions for surgery to be paid for but a consult is a different matter.

 

[Zigner]

Where did you get that the doc is out of network? OP hasn't met the conditions for surgery to be paid for but a consult is a different matter.

Having dealt with this matter recently, I am inferring.

 

[ecmst12]

Oh, you mean you're ASSUMING! Or just making it up! Why don't we go with what's actually been posted for a change?

 

[imajean]

Doctor is NOT out of network and they told me my insurance WOULD pay but failed to tell me what I had to do first. They assured me so I felt no need to contact insurance myself. I feel here it was a lie of ommission. I mean couldn't ANYONE be a candidate and have the insurance pay IF**************this or that. So I feel suckered.

 

[cbg]

It is ALWAYS your responsibility to know what your insurance will cover. The fact that you did not find it necessary to confirm the information is not the fault of the doctor.

 

[lealea1005]

It is ALWAYS your responsibility to know what your insurance will cover. The fact that you did not find it necessary to confirm the information is not the fault of the doctor.

Agreed.

OP, most insurance companies have strict protocol to be follwed and documented before agreeing to cover a patient's bariatric surgery. If you check with your policy booklet/their website/a representative/consulted your PCP, before making the appointment, you would have known what was required.

I mean couldn't ANYONE be a candidate and have the insurance pay IF**************this or that. So I feel suckered.

No...and IMHO, with your previous medical history of blood clots and surgeries, bariatric surgery would be extremely risky, at best.

I'm going suggest (again) that you send the claim in yourself. Even if the treatment isn't a covered service, the initial consult may be.