Assistant Surgeon Not With Hmo Posted: 12-21-07 21:53pm
Good Evening,
I need some suggestions! I belong to an
HMO through my employer. In March of this
year (2007) I had lumbar spine surgery.
The Neurosurgeon was listed with my HMO.
None of the other doctor's in his group
are with my HMO. I found out that my
surgeon used a doctor from his group as
the assistant surgeon. My HMO paid the
neurosurgeon at the negotiated rate. They
also paid the assistant surgeon (although
he wasn't with the HMO) at a rate that was
higher than the primary surgeon. I paid
the neurosurgeon my copay of $100. The
statement that I receive from the neuro
group reflects everything properly for the
primary. They show the full amount billed,
the HMO pmt, my pmt, and a "managed care
writeoff" with the total equal to zero.
When it comes to the assistant surgeon
they will not show a managed care
writeoff. They continue to show a balance
due. I spoke with my HMO and they said
that the assistant agreed that their
payment amounted to "payment in full". I
wrote the neuro group but the latest
statement still shows a balance due.
To make things really bad, I had cervical
spine surgery done in November 2007 - same
doctors - same situation EXCEPT both the
surgeon and the assistant each billed over
$50,000 each. I just received a statement
from them with a balance due of $119,000!
What approach should I take? Should I work
with my HMO first and tell them that they
contracted with the neurosurgeon, they
pre-authorized my surgery etc. or should I
work with the doctor's billing service and
tell them that they had other alternatives
namely not to use an assistant at all or
to use an assistant that was with my HMO.
Has anyone had similar experiences? Seeing
that statement for $119,000 is eating at
me.
