Feels like surgeon is trying to capitalize on our situation. Is there something I’m not understanding?
My brother was in a motorcycle accident just over two weeks ago. He went to the ER and was admitted to the trauma ward. He had MRIs and X-rays done where they found out he will need outpatient care to repair his ACL, PCL, MCL, and meniscus. They provided a recommendation for an orthopedic surgeon when he left.
We were told that surgeon had already taken a look at his file and was available to help out so I called and made an appointment as soon as possible.
Surgeon talked us through what needed to be done, answered questions we had about using a donor vs your own tissue (he said he doesn’t see a difference but he was going to not use a donor), and said since so much needed to be done he wanted to block out 3-4 hours for surgery. We were then scheduled for two weeks out.
They called back saying turns out doctor will be out of town at that time and we had to wait 4 weeks instead. My brother pushed them asking if there was anything sooner because he is literally posted up in a recliner in my dining room until not only surgery can happen but until he can heal from surgery. They said there was availability at a different hospital but it was out of network so we needed to get pre authorization from insurance and that takes a while so we’d miss the earlier date anyway.
I called my brother’s third party healthcare advocate resource to see if there was a way to speed up the preauthorization process for out of network hospital. They said probably not and it would likely not get approved since there are in network hospitals in our area. Plus he would have a higher out of pocket for out of network hospital and have a higher portion to pay after insurance.
From there I found other orthopedic surgeons and talked to their MAs to understand how far out they were on the surgery schedule. We had a consultation with one that we were really impressed with and they were able to schedule us for next week. He told us he only needed 2 hours for this surgery and he was going to use some donor tissue so he doesn’t have to take everything from my brother (easier recovery) and shorter procedure.
I called and canceled the procedure with the original surgeon. Very next day original surgeon called my brother and said there was a misunderstanding with insurance and pre authorization isn’t needed for this surgery or for the out of network hospital and that they can do surgery next week.
My brother said he’d think about it and get back to them. It feels like the original surgeon is trying to capitalize on our situation by scheduling a longer than necessary procedure when he doesn’t see a difference with donor vs. not and it seems like he has no regard for what my brother will owe insurance in the end. Because I talked to his advocate I know pre authorization is needed for both. Am I not understanding something?
submitted by /u/Flat_Violinist_8232
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