Help (Financial Question) - ThinnerTimes

stakeda · 07-22-2004, 01:34 PM

Dear All,

I have a major concern. I need your advise and/or experiences to help me through this.

Prior to surgery, Leslie told me that I'd have to come up with $4,750 (prepayment to Dr. Callery) prior to surgery. She said that the insurance companies have been paying slow, so Dr. Callery will need to be prepaid. She said that she would submit a claim to my insurance company (Blue Cross/Blue Shield PPO) after my surgery. (By the way, I was pre-approved by Blue Cross/Blue Shield PPO) She said that when she receives payment from Blue Cross, Dr. Callery's office would write me a check to reimburse me.

So, I borrowed the money. I am two weeks out. I called to follow up and make sure the claim was sent to my insurance company. They have received no claim as of yesterday. Last week, Leslie told me that she sent my claim in on July 8th. It doesn't take two weeks to go through the mail.

So, Leslie seems to be avoiding my calls. I called three times yesterday just to let her know that, per Blue Cross/Blue Shied, Leslie should submit the claim first to Blue Cross of California. (Because Dr. Callery is a Preferred Provider with them) They will pay MUCH MORE if she does this. But, she won't even return my calls. And, of course, Alicia rudely informed me that they are just "so busy that it will take Leslie a couple of days to return my calls".

I'm sorry to vent like this, but I'm so confused. I'm also afraid. I have to pay this money back to the person that loaned it to me. I am a single mother of two children, no child support for 11 years, and I'm living paycheck to paycheck. I can't afford to pay this $5k loan back myself.

Did any of you have to pre-pay for your surgery? Do any of you have Blue Cross or Blue Shield?

Any suggestions?

bridgetgirl · 07-22-2004, 01:57 PM

I have Blue Cross, I had to pay $1500 up front in counseling fees not covered by the insurance carrier. In your case that doesn't make sense, a little weird... you may want to call Blue Cross and see if it's ethical. You can go online to blue cross website to see if your claim has been received... thats what I did. But Dr. Callery has a biller, that is not Leslie... ask for the biller. I have spoken with her in the past regarding some financial issues. Since you paid them up front, you may ask that when the office bills for the surgery that they DO NOT accept assignment, so the check can be mailed directly to you, in your name... this is an option. Hope it helps.

Mary W · 07-22-2004, 02:12 PM

First ask to speak with the medical biller, if that doesn't work ask to set up an appointment to speak with Leslie in person, if that doesn't work go to the office and request a minute of Leslie's time. Stay calm, polite and business like, but persistant. If all else fails, leave a message for Dr. Callery to give you a call.

Good Luck,
Mary

Christina · 07-22-2004, 02:13 PM

I had at the time of surgery Blue Sheild California Care HMO. My sugery was covered 100% other then the $200.00 I paid at the hospital for inpatient charges. However, I was never asked or informed to pay up front.. that seems pretty sketchy to me.. but thats just me. Good luck with that.. and if I were you I would do what Bridget said and ask for the biller and find out from your Insurance company if they can cut the check to you.. whatever it takes.. sorry you are going through this two weeks out.. that sucks. How are you doing otherwise??? You doing good?? I hope so.

stakeda · 07-22-2004, 04:19 PM

Thank you ladies for your responses. I am happy to hear that I'm not over reacting. I have remained calm when speaking with the office. I am just going crazy inside. (with worry)

But, guess who called me this afternoon? Dr. Callery. He was just following up on me, since I'm a post op. I just love this man! So caring.

Anyway, I did bring up the situation with him. He has assured me that he will do whatever it takes to resolve it.

Bridget, I think it's going to end up like your situation. He said that Blue Cross of California will pay their "agreed upon amount" and then I'll owe the $1,500 consultation fee. I called Blue Cross of California and they say that this will be the case. So, if I have to come up with $1500, so be it. I can do it somehow. (Anyone want to hold a carwash with me?) LOL

J/K

So thank you SOOOO much for all of your help! You ladies are so great. So helpful and so smart. Must be hard being smart, pretty, helpful, great.....all in one package? Hummmm

No really, thank you for all of your advise.

I'll keep you all posted on this situation.

Suzanne-photog4fun · 07-22-2004, 06:21 PM

One postitive way to look at the $1500 it costs you is the fact that you're saving lots of money on food since your surgery. I saved a ton of money on "food junk" after surgery since I no longer eat so much as preop. This savings added up fast. Plus, we often stop buying the same "crap" for our kids and thus our family also reaps the rewards of a healthier lifestyle around food.
Hang in there with the insurance payment. Just be persistant and ask to speak with billing, not the receptionist. Insurance companies are often slow to pay. That's why it is so frustrating for doctors as they have expenses also and need to be paid.

stakeda · 07-22-2004, 06:33 PM

Yeah Suzanne,

I had already decided that this $1,500 was nothing compared to the years and years of a healthier lifestyle that I will have in the future. I am very grateful for all that Dr. Callery has done for me. If I have to pay $1,500. So be it. My concern was $4,750. That's alota money! You know?

Anyway, thanks again. I realize insurance companies take a while to reimburse. I will remain patient.

lealphachienne · 07-22-2004, 08:12 PM

It makes me so grateful that I have a good Blue Cross HMO plan. The only payments I've had were office co-pays. Even if I were to have to pay more, it sure beats paying for the whole $54,000 surgery.

Karen Wright · 07-22-2004, 08:29 PM

Your bill from surgery was $54,000!!!??? Damn...what did they do to you while they were in there? <LOL> My insurance sent me a statement and it said my surgery was around $39,000. They must've did something extra for you, honey!

stakeda · 07-23-2004, 10:15 PM

Well,

Dr. Callery has come through once again! He called me this morning, bless his heart; he (himself) spent an hour on hold while contacting my insurance company. Poor guy, I know he has better things to do.

And, he had good news for me. He arranged everything with the insurance company. He is sending me a refund.

By the way, pre-ops might want to make sure with Leslie EXACTLY what they will be responsible for prior to their surgery. There is, at times, a consultation and aftercare fee of $1,500 that the patient is responsible for. I have agreed to pay this fee. As I said before, well worth it.

Dr. Callery has provided me a wonderful TOOL to make me healthy again. I appreciate everything he as done.

Thank you Dr. Callery!!!