They Want The Money Back!

They Want The Money Back What Do I Do?

Dear Dr. Tirado,

I used to do my MUA's in what was a busy South Florida Surgery Center, where the MD billed for procedures that I didn't know were being done. After BCBS performed their investigations they determined that this Center had to pay back the money they paid to the center. Because they were out of network, my patient received the check for over 28k and handed it over to the surgery center.

Now BCBS wants the money back and they are asking my patient for it. BCBS has already said they would drop the patients converage if the patient didn't pay the money back and has even threatened legal action.

My patient came to me asking what they should do, and after calling the surgery center themselves to collect the money they were unsuccessful. "I assume the surgical center has spent the money already."

What should I do for them?

Confused...

Well Dr. Confused,

If you think that the surgery center is about to pay back the money to the patient...think again...

Many of the centers that aren't willing to support their doctors or show supporting documentation during an investigation are probably looking to open centers in other states right about now and duplicate the same ponzi scheme hurting many many more doctors and patients alike.

At this point you can contact the principles of the surgery center and try your best to negotiate some type of settlement, and or payback schedule on behalf of the patient. I find if they are a center that is based on honesty, integrity and keeping the doctors and patients best interest in mind, you'll probably be able to work something out.

However this isn't always the case. Unfortunately the center has placed you in a very precarious position as the middle man and this might result in a complaint to your board if you neglect the situation completely.

It may appear that you don't really have any legal obligation to the patient, but I would consult with your health care attorney to determine the extent of your responsibility. Most important here is to maintain an open communication line with your patient and try to be there when they tend to have questions regarding the center and your role.

Aside from that there really isn't much more you can do...


Won't doctors ever learn...

What really amazes me most here is that although these centers are being investigated, audited, sued, litigated, bill unreasonable fees, jumping ship to other states, these same doctors continue to perform procedures at these types of facilities thinking that the centers will change.

Doctors, if your only criteria for doing procedures in a center is "can I get paid" ...don't be surprised when you receive your subpoena to testify as a witness in a federal investigation.

Fool me once shame on you, Fool me twice shame on me...

Doctors, bottom line here is that we need to be more empowered and show more awareness in the MUA arena. Ask questions regarding the procedure on behalf of your patients and yourself. Find out about fees. Ask the surgery center questions like... "what takes place if the insurance company asks for money back from the patient", "what happens with co-pays, and deductibles", "what if none of the procedure isn't covered", "what are your normal fees for the procedure".

MUA doctors, contact the doctors that taught you the procedures and ask them what other types of problems might you experience in the MUA arena.What problems might they experience with surgical centers. Get them on the phone and ask them for help and answers in situations like this.

But most of all always follow your heart and do what is right for the patient.


Get Paid What You're Worth

Dr. Jason Tirado
www.drtirado.com