I have a quick question about paying for in-network services and procedures upfront. We’re in-network with Anthem BC in California, and my son is scheduled for wisdom tooth surgery. The oral surgeon’s office has asked us to pay the full cost of the procedure upfront on the day of the surgery, which is $5000. They will then submit the claim to our insurance, and we’ll receive a reimbursement check in the mail.
I was under the impression that with insurance, you typically only pay the copayment or coinsurance at the time of service, and the doctor’s office submits the claim. The patient would then be billed later if there’s a remaining balance. Is this upfront payment practice common and legal?
If the entire cost is the sum agreed upon or more than that agreed upon?
Depending on the kind of plan you have, most HMOs forbid providers from charging members more than what they are responsible for paying for in-network providers.
The service might need a pre-auth, and the supplier should try to obtain a good faith estimate.
The upfront payment is more common than you think. And yes, It is legal. Here is what I’ll advise, call Anthem BC to ensure that the surgeon is following their policies and to confirm the procedure. You may also ask the provider for a full explanation of why they want upfront payment and how they manage refund to avoid being put in an undesirable situation.
Before proceeding, be sure to double-check with both the provider and your insurance. though,