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Fair Warning to Other Women

UPDATE: Jamie, the office manager, called me today, 7/11, and canceled my surgery b/c of this review. She called it border line slander! It's the truth! They can put me through 3 invasive pre-requisites, but can't handle a review when they are in the wrong. They still have not been able to provide the information to me that my insurance company required the 3 tests mentioned below. I never heard back from Traci either. Jamie refused to let me speak with Dr. Newman. Not once was I ever confrontational in the office to any of their staff. When I 1st called about the situation, I was understandably frustrated, but I wasn't threatening or mean in the least bit. I would strongly suggest you double check anything Paradise Valley OB-GYN tells you regarding insurance approvals and requirements. I went through 3 invasive (vajajay invasive) pre-requisites they told me needed to be done in order for BCBS to cover a procedure. One of which was a painful biopsy. Turns out they weren't required at all. I found out they NEVER even called BCBS to verify they were necessary to have my procedure covered!!! Apparently, they got some claim denials on other claims and are having women go through invasive pre-requisites that a majority of insurance companies and plans do not require! The office staff blamed corporate. Corporate tried to blame the office staff. Traci, the director of revenue cycle in corporate, told me they don't call your insurance company to verify what is required. She e-mailed me The American College of Obstetrics and Gynecology guidelines and told me it details what is "appropriate". The ACOG guidelines are not the same as an insurance carriers requirements and to me "appropriate" just means what they can get away with billing to your insurance carrier. I'm incredibly frustrated I didn't verify the information myself and I'm pretty sure it's border line insurance fraud to perform not one, not two, but three unnecessary tests, and possibly an unnecessary office visit. I'm fairly confident a new patient office visit from 2017 is valid for 3 years and you can bill an established patient office visit with an in-office procedure on the same day. The office visit would most likely be denied inclusive to the procedure so I get why they would want me to come in again before my procedure. To get paid. Not because it's necessary. They told me an invasive ultrasound I had done in 2017 had expired and I needed to have another one before my procedure. Had that done. They sprung a painful biopsy on me during an office visit. An office visit they said I needed to come in for to go over the same info I told them last year in order for BCBS to cover the procedure. As far as the biopsy, another requirement of BCBS. I could have called my insurance company in the office to verify it was necessary, but obviously trusted them and went through with it. Then 10 days before my procedure they called me and told me I needed to come in again for an invasive screening. I had the same screening 14 months prior. Again, they told me it had expired. A screening that according to my age, I only need every 5 years. I'd also like to mention Traci told me the biopsy was needed to rule out cancer. Why would I need to have both a biopsy and a screening to rule out cancer, especially when I had the same screening 14 months prior. I should have just called BCBS!!! I trusted them and I can't believe I put myself through all of that. Not to mention the time I took off work and the incoming bills from their office, a radiologist, and the lab. I haven't even had my procedure yet! I will also mention they use an out of network anesthesiologist. I've already confirmed with his billing office they don't balance bill and will accept the in-network allowable as payment in full, but they wouldn't give me that information in writing so I'm a bit skeptical. I believe her name is Kelly, but she didn't even know what balancing billing meant. She told me she'd balance bill me for any co-insurance or deductibles. That's not balance billing! I am fully aware it's my responsibility to verify my own insurance benefits/requirements. Shame on me. Fair warning to other women to double check anything Paradise Valley OB-GYN says is required! Lastly, Dr. Newman is awesome.
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ID
#1300915 Review #1300915 is a subjective opinion of poster.
Location
Scottsdale, Arizona
Service
Paradise Valley Obgyn Customer Care
Reason of review
Poor customer service

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