Billing surprise

The final frontier. Deciding when, if and how.
tomas1
Posts: 1946
Joined: Tue Jul 23, 2013 5:12 pm
Location: Tempe, AZ

Billing surprise

Postby tomas1 » Thu Mar 21, 2019 5:42 pm

I have a very good Medicare supplement and didn't expect any billing surprises.
Today I get a bill for $500 from a "surgical assistant" whom Dr Avila brought in.
Big surprise is she's not covered under Medicare and I'm supposed to pay her.

I wonder how many other cronies he may have brought in?
I really worried about the anesthesiologist, but so far, so good there.

I'm going to the office tomorrow to bitch, but we all know how that'll end up.
If I have to pay her a nickle, I'm no longer going to him.

My general practice doctor has always been willing to check the prostate, PSA, and prescribe T and Tamsulosin.
Stay tuned, any suggestions?
85 years
Inject testosterone weekly.
Implant on 1/22/19 by Dr Avila.
Scrotal, hor. incision just over 1"
18cm AMS 700 CX, 3.5cm RTE 100cc res
Gleason 6 prostate cancer. Monitoring it for now.
Update: On my last biopsies the cancer wasn't found.

SW0110
Posts: 648
Joined: Sun Sep 02, 2018 6:15 pm
Location: Central Kentucky

Re: Billing surprise

Postby SW0110 » Thu Mar 21, 2019 6:33 pm

I have as yet to get any bills for mine. They will probably start soon. We have been paying off my wifes surgery back in december. Her last bill was 90 grand and we owed 600 dollars. Not bad. I was told my cost for implant will be aroubd 2700. Small price to pay for a hard erection.

Hope all is going well.
18 cm plus 1 rte titan installed March 2019. Revision March 2020 by Dr. Andrew Todd, Richmond KY. He replaced the titan with an AMS 700 LGX 18 cm cylinder plus 2 rte for 20 cm total length.

Larry10625

Re: Billing surprise

Postby Larry10625 » Thu Mar 21, 2019 6:44 pm

tomas1 wrote:I have a very good Medicare supplement and didn't expect any billing surprises.
Today I get a bill for $500 from a "surgical assistant" whom Dr Avila brought in.
Big surprise is she's not covered under Medicare and I'm supposed to pay her.

I wonder how many other cronies he may have brought in?
I really worried about the anesthesiologist, but so far, so good there.

I'm going to the office tomorrow to bitch, but we all know how that'll end up.
If I have to pay her a nickle, I'm no longer going to him.

My general practice doctor has always been willing to check the prostate, PSA, and prescribe T and Tamsulosin.
Stay tuned, any suggestions?



Don't pay it... you didn't ask for that person AND what are they gunna do? Repossess your implant? :D

Larry

DougAnd
Posts: 1536
Joined: Sun Jul 08, 2018 5:10 pm
Location: Melbourne, Florida

Re: Billing surprise

Postby DougAnd » Thu Mar 21, 2019 11:37 pm

My implant was no billing problem. My revision so far 2 bills. Medicare sends me instructions on what to pay and what not so I called on the first and told them that the govt told me not to pay it was not a legal charge. They immediately apologized and sent me a letter saying paid in full. The second bill was simply not yet processed by my supplement. So I paid the $14.90 that was my part and wrote a note that the rest would be paid by insurance.
I will be going for surgery #3 on June 19th. Can't wait to see how that turns out. I'm sure Medicare and my supplement will be sorry to have me as a customer. :lol:
LGX 18cm+3cmRTE 8 / 8/18 by Docs Saracino , Prody of FL Disfigured by Implant. Married 31 years, Functionally impotent 2+ years. 4" day of surgery now 7" inflated after VED 6.5" without. Pump moved 12/4/18 by Dr Kata

Maverick2dog
Posts: 139
Joined: Mon Apr 23, 2018 9:24 am

Re: Billing surprise

Postby Maverick2dog » Fri Mar 22, 2019 8:56 am

The first surgery I had an assistant surgeon that billed the insurance company. The insurance company said he was out of network. Actually he was in network and they ended up paying. You got to watch the docs and the insurance companies.

When insurance or Medicare is being used the hospital / provider should be responsible for only using covered surgical team members, unless we are informed and approve. Somehow that falls on us.

I have BCBS and before you talk to there reps there is a recording that tells you the information you are receiving, from them, is not a guarantee of coverage. The information I am using to make medical and financial decision. Best guess??

I wonder how many times my insurance company will pay for the same surgery that the Docs keep fucking up? I am at three times.

Mav
59 years old. Forth revision 10/2021
Third revision 9/21 moved pump replaced one cylinder AMS CX 21+ 3. Second revision January 31st 2019 AMS CX 21,+2CM RTE. First revision November 15th, 2018 24CM CX .5RTE. Implanted 4/2018, Titian 22CM 2.5 RTE

FreddyFree
Posts: 587
Joined: Mon Nov 06, 2017 12:43 pm

Re: Billing surprise

Postby FreddyFree » Fri Mar 22, 2019 9:04 am

In Canada everything paid for through our one payer system. Not even a penny, which would have been impossible since we eliminated it.

I feel sorry for Americans that have to nickle and dime, (note, no pennies) and research plans, doctors, hospitals and "people brought in".

A ridiculous system you have.
AMS 700 CX 18cm. x 12mm. With 3cm. RTEs. 10/10/18

tomas1
Posts: 1946
Joined: Tue Jul 23, 2013 5:12 pm
Location: Tempe, AZ

Re: Billing surprise

Postby tomas1 » Fri Mar 22, 2019 11:21 am

I slept on this last night and think I may 2 ways on it.

1. take the bill to my doctor's office and ask them to take care of it.
I don't expect any action by the people at the desk though.
I will tell them that I won't be a patient there if I hear more about it.
You guys are right, the doctor HIRED the assistant and any charges should be on him.

2. tell the surgical assistant's office the same thing about the doctor being responsible.
If they play hard ball, I have lots of free time and lets see what the courts say.

I obviously could pay the $500, but shouldn't have to.
Somehow, the bill I received said the total charge was $3816
It also says there is a $3316 adjustment.
Difference of $500. It said "surgical first assistants" are not currently recognized as Medicare providers and therefore cannot bill Medicare. That's why the bill was reduced $500.

Thanks for all the replies and suggestions. I'll keep you posted.
I guess if I get tired of fighting this, I'll pay the damned bill and put a lousy review on my doctor.
85 years
Inject testosterone weekly.
Implant on 1/22/19 by Dr Avila.
Scrotal, hor. incision just over 1"
18cm AMS 700 CX, 3.5cm RTE 100cc res
Gleason 6 prostate cancer. Monitoring it for now.
Update: On my last biopsies the cancer wasn't found.

DaveKell
Posts: 531
Joined: Tue Sep 04, 2012 7:39 pm
Location: Texas

Re: Billing surprise

Postby DaveKell » Fri Mar 22, 2019 12:14 pm

Ha. I just recently got bills for my spinal fusion as a result of a car wreck. The neurosurgeon was $62,000 and the week hospital stay was $280,000. Out of that our part is a little less than $1,800. The surgeon' bill came out to $7,750 an hour, not bad for an 8 hour day. I have no idea how the hospital justifies their astronomical amount. By contrast, my implant was a total of $160 out of my pocket.
Became DaveKell 2.0 on July 18th with Dr. Allen Morey in Dallas, TX. AMS 700 CX implant. 18cm with 5.5 RTE's.

oldbeek
Posts: 2454
Joined: Sun Sep 10, 2017 1:46 pm
Location: Los Angeles area

Re: Billing surprise

Postby oldbeek » Fri Mar 22, 2019 2:28 pm

DaveKell wrote:Ha. I just recently got bills for my spinal fusion as a result of a car wreck. The neurosurgeon was $62,000 and the week hospital stay was $280,000. Out of that our part is a little less than $1,800. The surgeon' bill came out to $7,750 an hour, not bad for an 8 hour day. I have no idea how the hospital justifies their astronomical amount. By contrast, my implant was a total of $160 out of my pocket.
They see big dollars from (car wreck) that is why auto insurance is so high.
82, good health, RP 7-2017, all nerves taken , PSA 0.05, 4-18,, .07 1/19,.05 4/19, .03 11-21, .04 11-23, implanted 4-1-18, Infra-pubic, AMS lgx 15 cm with 5cm rte. Implant at USC Keck. Dr Boyd and Dr Loh Doyle 6.5 x 5, 800 AUS 7-21-20

oldbeek
Posts: 2454
Joined: Sun Sep 10, 2017 1:46 pm
Location: Los Angeles area

Re: Billing surprise

Postby oldbeek » Fri Mar 22, 2019 2:37 pm

tomas1 wrote:I slept on this last night and think I may 2 ways on it.

1. take the bill to my doctor's office and ask them to take care of it.
I don't expect any action by the people at the desk though.
I will tell them that I won't be a patient there if I hear more about it.
You guys are right, the doctor HIRED the assistant and any charges should be on him.

2. tell the surgical assistant's office the same thing about the doctor being responsible.
If they play hard ball, I have lots of free time and lets see what the courts say.

I obviously could pay the $500, but shouldn't have to.
Somehow, the bill I received said the total charge was $3816
It also says there is a $3316 adjustment.
Difference of $500. It said "surgical first assistants" are not currently recognized as Medicare providers and therefore cannot bill Medicare. That's why the bill was reduced $500.

Thanks for all the replies and suggestions. I'll keep you posted.
I guess if I get tired of fighting this, I'll pay the damned bill and put a lousy review on my doctor.

Maybe your DR didn't know how to do it and called in someone to teach him. Your dr should pay his bill. Out of( medicare) network Drs are usually hot shots that are in so much demand, they don't need to screw with medicare. There are lots of them around LA and So Cal. My back surgeon went out of medicare network right after I had my back surgery. He was the best in LA.
82, good health, RP 7-2017, all nerves taken , PSA 0.05, 4-18,, .07 1/19,.05 4/19, .03 11-21, .04 11-23, implanted 4-1-18, Infra-pubic, AMS lgx 15 cm with 5cm rte. Implant at USC Keck. Dr Boyd and Dr Loh Doyle 6.5 x 5, 800 AUS 7-21-20


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