Question:
Refusal based on assumptions.

I made an appointment with a local plastic surgeon several months ago. The office kept hounding me for insurance information, even though I had not even stepped foot in the door. I finally gave them my information and the receptionist said she would have to reschedule my appointment due to a conflict. No problem only no one ever called me back. I called the office yesterday and the office manager told me that they cancelled my appointment because they attempted to get preapproval from my insurance company and it's a policy exclusion so they cancelled me because they assumed that I couldn't pay for it, the office manager actually told me to start playing the lottery if I wanted to have surgery! Did I mention that I had NEVER set foot in the office and had not provided any paperwork, so they had no idea what procedures I wanted. They only knew my name and insurance info--that's it, no height, weight, medical history, nothing! I was a little put back by this. How do they know I can't pay those procedures? How do they know that I don't have $25,000 burning a hole in my pocket? I just wanted a consultation, I wasn't going to book anything for at least another year to 18 months. Should I be irritated or is this stardard?    — jenn2002 (posted on July 29, 2003)

July 29, 2003
No, it's not standard. I don't know where you got this plastic surgeon's name, but there are many fish in the sea.
   — Leslie F.

July 29, 2003
WOW! It sounds more discrimination than anything. They must have been looking for something specific.The only thing I can think of, is they wanted to find out what the usual and customary charges were ahead of time and it must not have been what they liked. You can't possibly get a denial unless they actually sent in photos and saw the patient. Every insurance company has a review process to separate the cosmetic from the medical necessity. I would report them for sure and get a new PS without a doubt! This is NOT normal.
   — ZZ S.

July 29, 2003
Wow. I think I'd be picking up speed to run, You are right to feel insulted. For one, if they already checked your insurance, they asked if you were covered for cosmetics, not reconstructive. That means to me they want full cash, not ins reimbursement. But to assume that you would not have paid for it yourself, given a choice, is just plain stupid and bad business. So, if your insurance pays for reconstructive (and some docs DO know how to make this happen, because it IS recon), then you win. If you do choose to pay for it cash money, then THIS place certainly doesn't deserve it. Grrrrrrrr
   — vitalady

July 29, 2003
Hi J- We've all heard saying about what it means to @$$ume........LOL
   — Mea A.

July 30, 2003
Leslie is absolutely right, leave these cruel folks and go on to other reconstructive surgeons. There is a difference between cosmetic and reconstructive surgery, and surgeons come from a wide range of philosophies. The surgeon in Minnesota who did my reconstructive (breast reduction) surgery specializes in both areas, and was entirely sympathetic to my needs. His staff group was outstanding, all wonderfully kind and supportive. Keep looking, keep calling!!! Good luck!
   — Deborah M.

July 30, 2003
Run, don't walk, as fast as you can AWAY from this surgeon!
   — Kathy J.

July 31, 2003
AMEN to Kathy Jo. RUN!!! Do you actually want a surgeon like this to perform any kind of surgery on you? NOT!! You need to thank the Good Lord above that He gave you a sign before anything worse could have happened. Think no more about it. GO find you another Surgeon who will treat you right. There are dozens of Plastic Surgeons!!
   — Jeanette D.

August 1, 2003
Run, run, run, as fast as you can! Go get yourself another "plastics" man! Try to find someone affiliated with a bariatric group. My support group just had the 2 guys that are affiliated with my surgeon's group at our last meeting. They take practically every insurance and will also help you with getting things paid for PLUS these guys will waive or lower their fees for bariatric patients seeking reconstruction. They gave us advice on how to start collecting info even before surgery to justify the reconstruction. There are lots of others out there - check 'em all out!
   — Deborah F.

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