Share Facebook
Crohn's Disease Forum » Surgery » I Am Absolutely F**Ked


04-06-2014, 05:27 PM   #1
vivaelbirdo
 
Join Date: Mar 2014
Location: New York, New York
I Am Absolutely F**Ked

I had a small bowel resection 3 weeks ago at Mt. Sinai in New York. I did my due diligence beforehand:
1. I picked a good surgeon (Alexander Greenstein) who accepted my insurance
2. Confirmed that insurance was approved and being covered by company, and confirmed with Mt. Sinai that everything was in network and ready to go.

Well, I just got hit a $13,000 bill. Turns out, Alexander Greenstein is in network, *but his father Adrian Greenstein, whom he works with and shares a practice is not*. While Alexander performed the actual surgery, they do all surgeries together and it's billed separately. So, of the $40,000 charge from Alexander, I owe $2,000...which was expected. Of the $15,000 from Adrian, I owe $13,000.

I'm at a complete loss of how to move forward. I did everything I was supposed to do beforehand just to avoid this type of situation! I basically was informed that I am facing financial ruin because I was unaware they would both be in the operation room and that, despite sharing a practice, they take different insurance. I angers me so much...I talked to at least a dozen people at my insurance company. I spoke with Mt. Sinai's billing department, their staff and the doctors themselves about insurance beforehand and was assured everything was fine.

I don't know what else I could have done and am now facing the fact that this plus my previous hospital stay have completely destroyed my savings and am now some pretty deep debt. And this is someone WITH health insurance who did his fucking best to make sure everything was in network and approved.
04-06-2014, 07:43 PM   #2
nogutsnoglory
Moderator
 
nogutsnoglory's Avatar
 
Join Date: Sep 2009
Location: New York

My Support Groups:
That's awful. Contact the hospitals patient assistance department. I don't know what it would be called but all assist with financial hardship and maybe they can eliminate your debt or ease it. I'd also discuss this concern with the surgeon and maybe they will waive the fee.
04-06-2014, 09:18 PM   #3
Crohnsmomof3
 
Join Date: Oct 2013
Location: Indiana

My Support Groups:
Wow! That is so wrong!!

My only thoughts are that I would bring this to the attention of your health insurance. Once when I was hospitalized I had to have an infectious disease doctor to treat me. Well, he was not in network and they billed me for the full amount. I contacted my insurance and explained to them that I was in my hospital and had no way to check on the doctor to see if they were in network and he was the on call infectious disease doctor. So, again no choice on my end.

They had me write up a statement and my referring doctors at hue he time as well. So, in the end because I had no say who treated me they covered the cost. However, I could not willingly go to that doctor again and have it work the same way.

Anyway, that said I would contact your insurance agency and explain to them that you had no idea that another doctor (not in-network) would be in the operating room at all and you had no choice in the matter. It may not work, but it is definitely worth a try.

I hope this works out for you!
__________________
Leslie

Diagnosed: 2004
Abcess: 2011
TI resection 2013 (60 cm of small bowel)

Current: Stelara, Methotrexate, Questran, B12 injections

Past medications: pentasa, remicade, humira, cimzia, imuran, prednisone, entocort, 6mp
Adverse reactions: Remicade, Humira, Cimzia, Imuran, 6MP

Diagnoses: Crohn's Disease, Iron deficiency Anemia, B12 Anemia, Osteoporosis, Anxiety
04-06-2014, 09:41 PM   #4
afidz
Super Moderator
 
afidz's Avatar
 
Join Date: Jun 2012
Location: Mckinney, Texas

My Support Groups:
"I was unaware they would both be in the operation room"
I think its best that you seek legal help.
__________________
Crohn's since 2007
15 Abdominal Surgeries since 2008
Severe Non-repairable abdominal hernia
Ankilosing Spondylitis
Inflammatory Arthritis

Failed meds:
Humira
Remicade
Asacol HD
Cimzia
Methotrexate

Last edited by afidz; 04-06-2014 at 10:30 PM.
04-07-2014, 05:21 AM   #5
Terry
 
Terry's Avatar
 
Join Date: Aug 2013
Location: howlong, New South Wales, Australia

My Support Groups:
I am so sorry to hear about the way these supposed "DRS" so completely F**Ked you over, they must be getting down to there last millions to do this to a patient, sounds like they have Tag teaming down to a fine art. I wish you all the best and hope that you beat the bastards. Good Luck. Theresa.
__________________
iagnosed 1988 Crohns Disease.
Finished with Prednisone September 2013
Not on any Meds except Somac 40mgx2 daily
Right Hemicolectomy April 2014
Vitamin B12 injections 3 monthly.
04-07-2014, 07:21 AM   #6
Lisa
Adminstrator
 
Lisa's Avatar
 
Join Date: Apr 2010
Location: New York

My Support Groups:
I agree with contacting your insurance company again and explain to them (in writing) that your surgery was approved with 'dr x' - and you had no knowledge or control over 'dr y' being in the operating room. I would also tell the surgeon's office that your surgery was scheduled with the one doctor, and approved by the insurance company - their bringing in another doctor without prior approval by the insurance company is NOT your responsibility or 'fault' - the surgeon should have made sure all approvals were in place.

I would not make any payments until this is worked out - making a payment will 'admit' you are responsible for charges.


Tell the surgeons' office that this is under review by the insurance and make THEM (dr and insurance) duke it out - don't stress yourself out over it!

No matter what, remember that as long as you make any type of payment on a doctor bill, even if it is fifty cents a week, they CANNOT come after you and/or send the account to collections - as you are making a good faith effort to pay.
__________________

30 plus years and counting with UC/Crohn's!
on remicade since 11/05

While my experiences may not be what everyone has had- I feel it is worthwhile to share any and all experiences that may be beneficial to others.
04-07-2014, 08:19 AM   #7
Kero
Senior Member
 
Kero's Avatar
 
Join Date: Dec 2013
Location: Edmonton, Alberta

My Support Groups:
That is absolutely ridiculous! Not your fault at all. You did your due diligence only to have them screw you over. I would be seeking legal advice
04-08-2014, 09:13 PM   #8
cleverpun
 
cleverpun's Avatar
 
Join Date: Apr 2014
Location: Austin, Texas
Vivaelbirdo, have you thought about speaking with the billing surgeon directly? He is a human being and must have some human compassion. Perhaps hearing your story and understanding the circumstances he would be willing to discount his services or even cover the bill.

I was extremely fortunate and absolutely floored with gratitude when, after my emergency resection in 2001, my surgeon insisted on removing charges for his services. Sometimes people are better than you think. Although I agree with others that it could turn into a legal matter, realize also that no doctor wants to go through the hassle, cost or issues of a suit. Talk to him/her first.
04-09-2014, 10:28 PM   #9
Geriatric Jukebox
 
Geriatric Jukebox's Avatar
 
Join Date: Mar 2013
Location: Bayside, New York

My Support Groups:
Hi Vivaelbirdo,

I'm very sorry that you are going through this at a time when all you should be thinking about is your recovery. I hope you can get this resolved to your satisfaction. I go to Mt. Sinai for regular checkups with Dr. Ullman,for Crohn's and I was wondering who referred you to Dr. Greenstein. If I should need another surgery I don't want to have this happen to me.

Get well soon,

Alan
Reply

Crohn's Disease Forum » Surgery » I Am Absolutely F**Ked
Thread Tools


All times are GMT -5. The time now is 12:48 PM.
Copyright 2006-2017 Crohnsforum.com