I saw an In Network Surgeon (who has a private practice) who I had surgery with at the end of last year. All costs related to that surgery were covered in full (I had met the In Network Out of Pocket Max) except for $1,800. That $1,800 is a $200 “Case Presentation” fee which was billed 9 separate times. Unfortunately, the reason this wasn’t covered was NOT that is wasn’t “reasonable or necessary”, but that my plan specifically excludes this case code. Am I wrong for thinking that planning costs should be included (and therefor bundled) in the cost of the surgery? I agree that if the surgeon spent time on my case then he should be paid for it… but that should be included in the surgery costs, no? Insurance indicates since the service billed is not one that’s covered, I still owe it. But to me it seems like the issue is more of an ethics one in that, the services never should’ve been billed for at all. Thoughts?
submitted by /u/TassleZipper
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I saw an In Network Surgeon (who has a private practice) who I had surgery with at the end of last year. All costs related to that surgery were covered in full (I had met the In Network Out of Pocket Max) except for $1,800. That $1,800 is a $200 “Case Presentation” fee which was billed 9 separate times. Unfortunately, the reason this wasn’t covered was NOT that is wasn’t “reasonable or necessary”, but that my plan specifically excludes this case code. Am I wrong for thinking that planning costs should be included (and therefor bundled) in the cost of the surgery? I agree that if the surgeon spent time on my case then he should be paid for it… but that should be included in the surgery costs, no? Insurance indicates since the service billed is not one that’s covered, I still owe it. But to me it seems like the issue is more of an ethics one in that, the services never should’ve been billed for at all. Thoughts?
submitted by /u/TassleZipper [link] [comments]Read Morer/HealthInsurance