Saturday, November 10, 2012

Thank You for Not Ripping Me Off

After a very frustrating day yesterday dealing with a medical provider who essentially balance bills in advance--wants at least some of the money that falls between what they want to charge and what the insurance company will pay as reasonable and customary--I want to take a minute and thank someone.

I want to thank my plastic surgeon who did a very good job on my two DIEP surgeries. She didn't balance bill me at all. Her staff worked to get an in-network exception since she also isn't in-network with most insurance. An in-network exception means the insurance company admits they don't have a doctor in-network who can do this type of work, and because of that, they will cover costs at an in-network rather than out-of-network benefit level in this case.

She took what she got from insurance this way and then what I would have had to pay through my in-network co-insurance, etc (I had none for either of these surgeries as other treatment quickly pushed me past our family's out of network max for the years) and called it good. I never saw a bill for that "gap cost," the amount between what she billed and what the insurance paid.

So I know it can be handled better, that plastic surgeons who choose to take reconstruction patients with insurance can (and should) work to get the better in-network benefit level for both them and the patient and then call it a day.

After all, they are often working with patients who have endured years of paying out-of-pocket-maximum levels on their insurance. To ask for more is simply greedy and unprofessional in my opinion.

In fact, my biggest pet peeve is "billing coordinators" who try to defend and/or explain their policies that plain and simple rip off cancer patients looking for reconstruction. Asking for any dollar more than you are due via the best insurance agreement you can work to get is wrong.

Sadly, there are a lot of them out there, especially if you need a more specialized type of reconstruction.

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