U.S. CitiesCity-Data Forum Index
Covid-19 Information Page
Go Back   City-Data Forum > General Forums > Health and Wellness
 [Register]
Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
View detailed profile (Advanced) or search
site with Google Custom Search

Search Forums  (Advanced)
Reply Start New Thread
 
Old 08-29-2010, 01:30 PM
 
Location: My little patch of Earth
6,193 posts, read 4,720,046 times
Reputation: 3048

Advertisements

Second doctor charges question.

Two months ago I had rotator cuff surgery.

I get my bill and find another doctors name (along with the doc that did the surgery) on the bill along with $4800 in charges not covered by my insurance.

Any recommendations on recourse?

I was not told of the other doctor pre-surgery.
Reply With Quote Quick reply to this message

 
Old 08-29-2010, 03:39 PM
 
Location: Mostly in my head
19,865 posts, read 57,906,987 times
Reputation: 19182
Many times doctors have assistance in the OR from another surgeon. Patients aren't told who all will be in the OR. If your insurance covered the lead doctor, they should cover the assistant. Appeal.
Reply With Quote Quick reply to this message
 
Old 08-29-2010, 04:23 PM
 
Location: Georgia, USA
25,151 posts, read 30,047,716 times
Reputation: 31269
Quote:
Originally Posted by wrench409 View Post
Second doctor charges question.

Two months ago I had rotator cuff surgery.

I get my bill and find another doctors name (along with the doc that did the surgery) on the bill along with $4800 in charges not covered by my insurance.

Any recommendations on recourse?

I was not told of the other doctor pre-surgery.

You need to talk with the primary surgeon's office and find out what the second doctor actually did. It is not unusual for there to be an assistant during surgery, but today that person is frequently a physician's assistant or a specially trained surgical tech, not an MD. If the procedure required a second surgeon, the primary surgeon should appeal the insurance company's refusal to pay. This usually means a letter from the surgeon and a copy of the "operative note", which is a technical description of the entire procedure from start to finish and should justify the need for another set of MD hands.

Never pay an insurance company denial until you exhaust all your appeal options.
Reply With Quote Quick reply to this message
 
Old 08-29-2010, 04:46 PM
 
Location: Tigard, Oregon
863 posts, read 2,656,834 times
Reputation: 671
Good advice and be PERSISTENT!
Reply With Quote Quick reply to this message
 
Old 08-29-2010, 04:53 PM
 
Location: Cartersville, GA
1,256 posts, read 3,068,220 times
Reputation: 1090
Was the other physician an anesthesiologist, by chance? They often bill sepearely from the surgeon. Their serivice is usually covered by insurance, though.
Reply With Quote Quick reply to this message
 
Old 08-29-2010, 06:21 PM
 
Location: My little patch of Earth
6,193 posts, read 4,720,046 times
Reputation: 3048
Thanks all. I'll be making inquiries tomorrow.

The anesthesiologist was separate.

I will appeal in each case.
Reply With Quote Quick reply to this message
 
Old 08-29-2010, 06:38 PM
 
4,805 posts, read 20,764,020 times
Reputation: 4990
Yes, appeal. I had a similar experience--the doctor and the procedure were approved, but then the insurance company denied coverage for some other people in the room who apparently worked on contract for the hospital and weren't employees. They said I didn't get approval for them. I appealed, stating that I was never informed that there were any contractors involved in my treatment, that everyone present was wearing hospital identification, and that I was UNCONSCIOUS during the treatment so I couldn't have stopped it even if I'd known they weren't employees of the hospital.

The insurance company ended up covering all of the separate bills.
Reply With Quote Quick reply to this message
 
Old 08-31-2010, 02:11 PM
 
15,406 posts, read 20,589,908 times
Reputation: 22164
That happened to me with two different surgeries. In one case the doctor was using Physician Assistants to do several surgeries, in the same OR at the same time, while he "oversaw" all of them. In the other case (a life-saving surgery), the doctor performed the surgery and had an assistant watching/helping.

I felt that my insurance company was justified, in both cases, to refuse to pay the assistants' fees. I called the surgeons' offices and told them that I didnt authorize anyone other than the doctor himself to perform the surgeries and that I could not/would not be held financially responsible for the assistants' charges. I never got another bill and no one ever tried to collect on those charges.
Reply With Quote Quick reply to this message
 
Old 10-20-2012, 04:01 PM
 
2 posts, read 1,577 times
Reputation: 10
Please help its been 12 years since i had 2 total hip replacement(both in 2000). However, i just open an envelope which contain my medical records last night stored in my basement file cabinet. enclosed i discovered on 8.28.2002 i found a complete operative report with details such as, admit date/discharge dates, nurses notes, listed various other surgeons, that i had another hip replacement (never happen in 2002), physical therapy notes, 2 lot # concerning implants, surgical pathology report and the list goes on. can someone please explain to me what can been done lost for words.

help lost for words
Reply With Quote Quick reply to this message
 
Old 10-20-2012, 04:35 PM
 
Location: In a house
13,253 posts, read 37,840,120 times
Reputation: 20198
Quote:
Originally Posted by HIPWHIP View Post
Please help its been 12 years since i had 2 total hip replacement(both in 2000). However, i just open an envelope which contain my medical records last night stored in my basement file cabinet. enclosed i discovered on 8.28.2002 i found a complete operative report with details such as, admit date/discharge dates, nurses notes, listed various other surgeons, that i had another hip replacement (never happen in 2002), physical therapy notes, 2 lot # concerning implants, surgical pathology report and the list goes on. can someone please explain to me what can been done lost for words.

help lost for words
I'm not sure what kind of help you're looking for.

1. You know whether or not you had surgery in 2002. If you know you didn't have it, then you didn't have it.
2. You are the most likely person to have put that report in your cabinet in your own basement. So back in 2002, when you received it, you must've had some idea why you had it.
3. If you're worried about a debt, stop worrying. I don't know of any state that has a 10-year statute of limitations for collecting on a hospital debt.

You're asking what can be done -

what can be done about what, exactly?
Reply With Quote Quick reply to this message
Please register to post and access all features of our very popular forum. It is free and quick. Over $68,000 in prizes has already been given out to active posters on our forum. Additional giveaways are planned.

Detailed information about all U.S. cities, counties, and zip codes on our site: City-data.com.


Reply
Please update this thread with any new information or opinions. This open thread is still read by thousands of people, so we encourage all additional points of view.

Quick Reply
Message:

Over $104,000 in prizes was already given out to active posters on our forum and additional giveaways are planned!

Go Back   City-Data Forum > General Forums > Health and Wellness
Similar Threads
Follow City-Data.com founder on our Forum or

All times are GMT -6.

© 2005-2020, Advameg, Inc. · Please obey Forum Rules · Terms of Use and Privacy Policy · Bug Bounty

City-Data.com - Archive 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35 - Top