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Fraudelent PM? Need opinions!

scottishkrumpetsscottishkrumpet Posts: 35
edited 06/11/2012 - 7:48 AM in Health Insurance Issues
I went to a new PM that was referred to me by the NS that was part of a neurology group I went to for treatment with the PM. When I called for an appointment and asked about my insurance, I was told that he doesn't accept any insurance but Medicare. That disqualified me as I had a medicare advantage policy so technically I didn't have medicare but my plan had out of network benefits. After MUCH thought, I decided that I would pay the necessary co insurance for visits so I could continue my pain management needs.
My insurance sent me/them a notice that they will not be paid unless they furnished the proper code for my claim. I talked to the dr's office and the receptionist asked ME to call my insurance and she proceded to tell me the code and my diagnosis code BUT SHE WOULD NOT CALL.
She told me each epidural was his fee of $3500.00, then I would be billed for my the anesthesiologist and I would also have to pay for use of the surgical facility.
Why will this dr. charge these fees and accept paultry medicare, it's somewhat like hanging a chandalier in a log cabin.
Does anyone here have a similar experience with this type of setup? I really want to stay there for the convenience of the proximity of the office, but I am flat out unable to give anyone or anything money like that. He is also pressuring me to have three epidurals 1,2,3 just like snapping his fingers and I feel like he will abandon me if I don't just snap to it. I'm so perplexed!



  • It sounds to me that this PM is a bit of a money grabber. I'm from Canada and are health care is taken care of thank-god!. Is it normal to have three epidurals just like that? It's your decision to take what is offered by any kind of doctor. so, if you feel this guy will drop you because of that this guy is not worthy of your money or time! I know it's so much easier when they are close but at the same time I think you just bite the bullet and if you have to go more of a distance for someone you feel good about it's so worth it!

    Just my suggestion...

  • and, I am a medical receptionist and you are so right! She should be calling not you! She is just being lazy....
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  • Scottish,

    I guess if I were in your shoes, and since now you know they won't call your insurance, I would seek out another PM. Have you mentioned any of this to your Neurologist? He may be able to get this all fixed? Sorry you're going through all this. *HUGZ*

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Wow. That's expensive!

    He sounds like a boutique doctor. He probably accepts medicare because he has to due to some contract. Besides that, he "just doesn't do insurance."

    Did you know there are doctors who even charge a fee for the right to go see them? Like a monthly fee. Then, you have to pay again when you actually see them.

    You do have to wonder about PM doctors who make a living via cash patients (hmmm), but definitely not at the expense of YOU getting good care. Find someone who takes your plan!
  • I went to a spinal pain center and they also wanted me to do three epidurals - actually set me up for ALL 3 appts for them and wanted to sign a pain contract agreeing to have all of them. Would not even listen to my questions of "well maybe the 1st or 2ed one will work" and I won't need a 3rd.

    THEN later in the conversation I was told "be ready to do this again in 6 months" when said why their response was "your insurance won't pay for more until then".

    Sounds like you have the same money grabbers set up I had.

    I did not sign the papers and my new PM said that the treatments would not have been best for me and he doubts would have worked any ways....

    Please keep us updated how things work out for you :)
    L1 - S2 "gone" useless in 1 way or another. DDD. RA. Bone Spurs. Tons of nerve damage/issues. Stenosis. Both knees replaced. 50 yrs old. I had a great fall (hence my user name) at age 41 and it has been a domino effect every since.
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  • SpineAZSpineAZ WiscPosts: 1,084
    Ms. Humpty Dumpty:

    It is true that most insurance will cover two sets of ESI a year (basically one every 6 months). A set is 3 shots. Medically it is preferred to not have the injections more than twice a year as they are steroids. I did need one "out of cycle" and the insruance staff at my PM office applied to insurance for an exception and it was granted.

    ESI are expensive due to facility fees, doctor fees, anesthesia fees, etc.

    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
  • What Spine AZ said- sets of 3, 2 a year. I also had one out of cycle due to a flare.

    And they are hellish expensive even with insurance contracts, I don't even want to know what my own doctor's cash price is.

    I will tell you, I'd be in there for more now, at the 6 month mark, if I wasn't coming up on surgery. They don't last even that long for most people. So, I wouldn't label them money grubbers until you try it- for a lot of people they work, but only for a few months.
  • I do not know where you live, but here in Las Vegas pain mgmt offices are a dime a dozen, as are chiropractors and personal injury attorneys and are all competing for business offering new patient incentives, reduces rates, special billing/payment options, flexible hours, etc.

    I would recommend finding a PM office that values your business and is willing to do their job, treating you with respect that a patient deserves. Good Luck
  • If this man only accepts medicare, does that mean he will drop his fee from 3,500 to the 662 that medicare pays for this?
  • I had a PM who was giving me 2-3 injections every month and insisting that with the injections, he could restore my back to 80%. It took me 9 months before someone told me that that was far too many injections; and for me to wise up, as each injection was only lasting about 2 weeks. That was also about the same time that I received a statement from my insurance carrier showing what they had been paying every month, which was on average, over $10,000. It's no wonder, why some of them become injection happy and the money means more than the welfare of the patient.
    Convenience could wind up costing you far more than driving a little farther. The best way to find out about a PM is to talk with others that see them. Maybe someone else will chime in with a recommendation on the best way to meet others in your area who also suffer with back issues.
    Best Wishes,
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