Hotscot

We have excellent coverage via Anthem Blue Cross but hardly needed more than an aspirin in the past decade.

Varicose veins been giving me gyp recently.
Doctor recommended surgery to take them out, quite routine.

Hands me over to the accountant person who asks me to sign a waiver and give 3K upfront in case the insurance company declines to pay.

I naively ask if we can request authorisation from Anthem before committing to it.

Oh no they won't tell you in advance, you need to pay upfront then they may or may not agree to pay, even if the Doc considers it medically necessary...WTF!

And morons like Palin spout about rationing and death panels under ACA?

Speedwell

Bulls***. Call Anthem yourself and don't sign anything.

Trixie_b

wot they said

Hotscot

You think that approach may help? I've never navigated this before....thanks.

sir_eccles

Price transparency is a huge deal in the news right now. Call Anthem yourself before signing anything. You may need the precise procedure code.

RoadWarriorFromLP

The medical provider should be the one to contact your insurance company for approvals. If the physician isn't willing to do that, then go to a different doctor.

But good luck trying to get a price quote in advance if you have insurance. Neither the insurer nor the medical providers will do that for you, unless you negotiate a cash price (which you probably shouldn't, being that you have insurance.)

This doctor sounds dodgy. I'd be inclined to go somewhere else.

NatashaB

Every medical office I've dealt with has been happy to confirm insurance coverage before proceeding. Yours sounds very unhelpful. Get the codes and call the insurance yourself.

steveq

Surgery isn't the only option, they can be sealed by diathermy or injected surgical sealants. have you been offered only the expensive choice ?

Tegwyn

This is a doctor issue not an insurance issue. They may be doing this because the insurance company may have had issues with their billing or treatment practices before. You need to ask your insurance company if they have had problems with them before continuing with this procedure.

angelman

This sounds like a scam. My mantra is "assume everyone involved in medical field is a con artist, never pay a bill until you get the final summons in red, check and recheck every bill and cross reference it with your EOB, argue every point you can until you get the billed amount you expect." I have probably saved $1000s in medical expenses this way. I have friends who routinely spend $1000s on bills they do not need to pay. Certainly I would never give anyone money up front (well not more than $100 maybe) just in case. Go to another doctor.

Hotscot

It was the treatment the doctor recommended...I may try a different office.
Failing that I'll find out the code if I can and call Anthem.

RoadWarriorFromLP

A surgery will probably involve at least three bills: the physician, the hospital/ surgical center and the anethesiologist.

You aren't going to get all of the CPT codes in advance. And even if you had them, you won't get a price quote from anyone.

The demand for an upfront payment is a red flag. Either the doctor isn't in your network, or else they want to overbill you.

jeffreyhy

Did the doctor give the options as well as the recommended choice? I would, and not just because of the requested prepayment. This sounds like optional surgery, at this stage anyway (it might become required in the future if not dealt with now in some manner), so I would get a second opinion as to how to deal with the problem.

Hotscot

Ok. First step I'll try another Doc.
Thanks all!

penguinbar

I would call my insurance company and try another Dr. My mom had surgery on her varicose veins a few months ago. It was outpatient and very routine. She didn't even need her prescription painkillers. She's nearly 70 and said she wished she hadn't waited so long.