quote:

Iwould think they should be able to bill you immediately so its covered under current year insurance even if the surgery takes place early next year.
 
Posts: 4074 | Location: Boise, ID USA | Registered: February

^^^^^^^^^^^^^^^
That would be insurance fraud.

Why would pre-paying for service that he is actually going to receive, be fraud? I can pre-pay for just about aby other legitimate service.

If I were colluding with the provider to bilk money for services that are not going to be performed, that would clearly be fraud, but in this case the person who is going to receive the service is essentially receiving a discount by paying in advance. I personally know somebody who did something similar when he was going to be laid off by an employer that had provided dental insurance. The employee went to the dentist prior to the company’s downsizing and arranged for insurance pre-payment for the work that needed to be done, payment was made, and treatment was rendered over the next few months, after the employee was terminated.

How was this fraud? The person had been paying insurance premiums all along, and wanted the insurance company to cover the cost of treating a condition that had developed during the time period that he had been paying the insurance company’s assessed premiums. Treatment was paid for at the standard rate and subsequently delivered. Fraud? I don’t think so.

Would there be anything wrong with one of your patients pre-paying for specified service that is actually going to take place? What difference does it make whether the funds come from the patient’s pocket, or from insurance coverage for which the premium costs were paid by funds from the same patient’s pocket? Why is pre-paying for service from a surgeon wrong? I can pre-pay for any other service and in some cases receive a discount for pre-paying.

quote:

Originally posted by V-Tail:
Why would pre-paying for service that he is actually going to receive, be fraud? I can pre-pay for just about aby other legitimate service.

What's the limit? How much medical care can you 'pre pay' to bilk the system for stuff?

I'm sure in the insurance clauses, services have to have been delivered, or something like that, which would then make it fraud...

Not to mentioned the OP wouldn't be 'pre-paying', since he'd only be paying like 10% of the service, if that.

I'm sure the surgeon/hospital would love to take a prepayment, however, if the provider(s) bill the insurance carrier without having performed the services, they would be the one to get in trouble.

Shit happens. I had scheduled the surgery on my ear last June. It was in the latter half of the day. I get a call a month later from the nurse that she screwed up and had just found out that on that day he was leaving at noon. The earliest I could reschedule was two months later.

Yeah, I was not at all happy but this guy is an excellent ENT so I just lived with it.

Hey Chxxx sorry your having shoulder issues and not getting the surgery needed on time.

I'd be pissed but if I trusted the docs services then I'd stick with him.

Guess one way to look at it is you will have a hopefully early start to meeting next years deductible.. ... also keep us updated.

Your a stand up guy and I still remember you sending my wife flowers when she had back surgery many years ago...

quote:

Would there be anything wrong with one of your patients pre-paying for specified service that is actually going to take place? What difference does it make whether the funds come from the patient’s pocket, or from insurance coverage for which the premium costs were paid by funds from the same patient’s pocket? Why is pre-paying for service from a surgeon wrong? I can pre-pay for any other service and in some cases receive a discount for pre-paying.

^^^^^^^^^^^^
The insurance companies bury this sort of thing in the small print. It is the provider who is in trouble if they bill in advance for a service that is not yet performed. You can prepay for the service, but the insurance company cannot be billed until the service has been completed. This sort of thing happens with dental insurance when you prepay for a crown that has not yet been placed. Technically, the dentist cannot bill the insurance company until the crown has been placed in the patient.

Short answer!

Change doctors

quote:

Originally posted by grumpy1:
Wow, sorry to hear that. I doubt you will get any sooner with a new doctor especially this time of year as there is always a year end rush to get medical stuff done to take advantage by those that have met their deductible or out of pocket maximum. Does your doctor have a history of doing this or is it unusual? If he has a history of doing such frequently then it may be time to look at some other doctor. If not then it is probably best to wait it out.

He may not get the surgery any quicker, but having a more trustworthy reliable doctor would be a benefit. At least in my view.

quote:

Originally posted by SpinZone:


Fair enough. Perhaps I should have said "her office policy is that it is unprofessional to discuss the doctor's personal issues with a patient. Your office, your rules but as a peon in the medical field for 30 years this is her norm.

I didn't think this was your wife's idea or rule. I think her bosses are dead wrong in their customer service outlook, and to cloak it in "professionalism" is nonsense. I mean no criticism of her. I know she has to follow the rules.

Shit happens. Maybe he’s had to perform emergency procedures and he needs to reschedule. Maybe it’s not even him. Could be anesthesiologist or someone else he’s working with. I cut my doctors slack. I don’t want them rushed.

quote:

Originally posted by Mustang-PaPa:
Hey Chxxx sorry your having shoulder issues and not getting the surgery needed on time.

I'd be pissed but if I trusted the docs services then I'd stick with him.

Guess one way to look at it is you will have a hopefully early start to meeting next years deductible.. ... also keep us updated.

Your a stand up guy and I still remember you sending my wife flowers when she had back surgery many years ago...

Hey man that was a while ago.

I texted the doctor last night after I had cooled down and told what a fucking mess he made, likely not only with me, but others too. I admitted I didn't know his circumstances, and could be a complete dick in telling him that, but let him know that the timing was worse for me than the money.

He texted me back at 9:00 telling me that they are opening a new surgery day on 12/26, and I would be expecting a call. My guess is that they got a few calls from people by cancelling both the 12/17 and 12/19 dates.

I am now rescheduled for the 26th, and have my follow up scheduled too.

Sorry for being such a cux bitching about first world problems y'all.

quote:

Originally posted by 280nosler:

quote:

Originally posted by Mustang-PaPa:
Hey Chxxx sorry your having shoulder issues and not getting the surgery needed on time.

I'd be pissed but if I trusted the docs services then I'd stick with him.

Guess one way to look at it is you will have a hopefully early start to meeting next years deductible.. ... also keep us updated.

Your a stand up guy and I still remember you sending my wife flowers when she had back surgery many years ago...

Hey man that was a while ago.

I texted the doctor last night after I had cooled down and told what a fucking mess he made, likely not only with me, but others too. I admitted I didn't know his circumstances, and could be a complete dick in telling him that, but let him know that the timing was worse for me than the money.

He texted me back at 9:00 telling me that they are opening a new surgery day on 12/26, and I would be expecting a call. My guess is that they got a few calls from people by cancelling both the 12/17 and 12/19 dates.

I am now rescheduled for the 26th, and have my follow up scheduled too.

Sorry for being such a cux bitching about first world problems y'all.

Hey, it would've cost you a lot of money and a lot of hassle by missing your slow period. Glad to hear it all worked out. Sometimes going straight to the source (Dr.) instead of the front desk helps. Glad it all worked out for you.

quote:

Originally posted by 280nosler:

I texted the doctor last night after I had cooled down and told what a fucking mess he made, likely not only with me, but others too. I admitted I didn't know his circumstances, and could be a complete dick in telling him that, but let him know that the timing was worse for me than the money.

He texted me back at 9:00 telling me that they are opening a new surgery day on 12/26, and I would be expecting a call. My guess is that they got a few calls from people by cancelling both the 12/17 and 12/19 dates.

I am now rescheduled for the 26th, and have my follow up scheduled too.

Sorry for being such a cux bitching about first world problems y'all.

Well hell that seems to have worked itself out by calling the doc and letting him know.

Also your not bitching your just venting and thats good. Sometimes it just help to talk about it or we get advice that helps with the problem or it just jogs the brain and helps think it out to be able to address the problem with the source as you have done here.

Good to hear, glad he took care of you and the others, I'd imagine most of the patients in DEC are getting it done with fully covered medical having deductibles met.

Lots of folks nowadays put off surgery and medical service due to the high deductibles and only do so once the family has met them...

Sounds like your doctor is a good guy. IMO most of them are and they really care about their patients. Surgeons have a very unpredictable job. I had surgery a few years back that was supposed to last about 2.5 hours and ended up taking 7.

My oncologist called me after hours about test results this summer and we talked about half an hour. I never got billed for that.

My primary MD retired a couple years ago but he worked insane hours. When I was in hospital he was always there around 4:30 AM every day to check up on me and his other patients before going to his office for day. He always had a smile on his face and very helpful.

Hope all goes well with your surgery.

I’m sorry that happened to you and I’m glad it sounds like there’s a reasonable compromise. I’ve always been very careful about taking time off but unfortunately things do come up and cases have to be rescheduled. I always try to do the makeup day as close as possible to the originally scheduled date. Essentially a surgery impacts at least two people as someone has to be available to drive the patient home and care for them in the early post op time frame.
My old job was very poorly run by the management and I didn’t hear half the things that were reported by patients. I typically give patients my cellphone number if they seem like reasonable folks. I’ve never had anyone abuse it thus far. I hope you have a smooth surgery and a speedy recovery!

quote:

Originally posted by 280nosler:...

Sorry for being such a cux bitching about first world problems y'all.

Bone on bone, with the weight of your arm and the constant motion day and night?

First world bitching, my ass.

I am glad to read you have a new slot.
Have a Merry Christmas and here's to the best outcome.

quote:

Originally posted by 280nosler:
Sorry for being such a cux bitching about first world problems y'all.

Nope. Far better to come here, vent among your friends, get some input, then approach the doc once you’ve cooled off a bit and let him know the problem this created for you. Glad that he responded as he did. Best wishes for a smooth surgery, a speedy and full recovery, and an excellent result!

quote:

My primary MD retired a couple years ago but he worked insane hours. When I was in hospital he was always there around 4:30 AM every day to check up on me and his other patients before going to his office for day. He always had a smile on his face and very helpful.

Does anyone remember when Doctors made house calls....and charged just a couple of bucks?