Sudden increase to be billed less than a week before procedure

[u/Derritiendose]

Hopefully this is the right place to post, any help would definitely be appreciated. Located in Texas.

I'm set to have a radio-frequency turbinate reduction procedure done in less than 2 weeks. I had a scan and scope done, did a few weeks of a nasal spray which did not help, and they now said I was eligible for the procedure.

I was initially quoted the surgeon's fee as $1,600 about a month ago, for a payment that is now due this week. Late last week I was sent an email advising that a medical code-change occurred after staff reviewed my procedure again and my new total is $2,700. I was told both totals accounted for my deductible being met and my yearly out-of-pocket due. I had no follow up visits related to the procedure since the original cost was given. Very frustrating as this is over a $1,000 difference that suddenly has to be accounted for on my side. They do allow financing but that depends on how much I'm willing to deposit.

Is this normal? Can it be negotiated? Are my only options to accept or find another surgeon? I'm a bit at a loss as this was something that would seemingly have a big change on my life and now I'm suddenly having to recalculate all my expenses last minute. Also I probably would have checked for other locations to quote if I was given this new cost earlier. Now I either have to cancel, delay the surgery another month while I think it over, or just go with the sudden increase.

[u/Environmental-Top-60]

Where is this being performed? Is this at a hospital or a ambulatory surgical center?

[u/Derritiendose → u/Environmental-Top-60]

Out-patient, same hospital where the ENT office is located.

[u/Environmental-Top-60 → u/Derritiendose]

OK. So two things with this. This is not the only bill you are going to have. You are going to have about 4 or 5 of them.

Physician, anesthesia (& CRNA) facility, pathology, assistant surgeon

[u/Environmental-Top-60]

If they change the code, that means I did there was a change in the surgical plan or they did not capture the correct code initially and or they found out in the prior authorization process at the insurance request. A different code be used.

What can you do about it? You won’t really know until you get the procedure done for the most part. However, you can look up the market value and see what the facility fee and physician fee should be as an out of network basis and see if if it’s cheaper to work it out with them such as paying cash for the physicians fee.

If you make a certain amount of money, having this procedure done at the hospital may make more sense if they have hospital charity care in which you qualify.

By doing that, that should lower your out-of-pocket cost for the surgeon. However, you are going to want to get preapproval from the hospital expeditiously not only for the charity care, but that this procedure is going to be covered under that policy.

You’re gonna have to show them that it’s medically necessary and notnecessary not cosmetic in nature..

[u/Derritiendose → u/Environmental-Top-60]

What frustrated me is when talking with the billing specialist is I said if there were no follow up visits since the original quote then it looks to me like an error was made. She said there was no error, and that it was only a small increase. I said I didn't think $1,000 was a small increase. I guess it could have been something related to them adjusting a code due to insurance but that wasn't mentioned by the person I spoke with.

I think with all the different things to be billed I'll just take the hit through insurance. The other fees I'm expecting but this was the only one where I was advised of a sudden increase.

I looked it up just now and don't believe I'd qualify for charity care, but I do tend to push hard for savings or negotiate when I see it as an option.

Appreciate you taking time to review this and letting me know your thoughts! I guess I will just move forward with it.

[u/Environmental-Top-60 → u/Derritiendose]

Did they decide to do two sides at once instead of one? That would also increase the price about 50%. It’s called a modifier 50.

[u/Derritiendose → u/Environmental-Top-60]

They had mentioned doing both since the initial visit. I asked if something specifically was changed in the procedure and kept getting vague answers, only being told 'a code was changed'.

[u/Environmental-Top-60]

And by the way, this is the perfect place to post this