Dr. Moynihan is a skilled surgeon, as long as money is no object. My husband suffered a traumatic nasal fracture after a crash during a bicycle race. After having a closed reduction by an ENT, my husband was referred to Dr. Moynihan for a rhinoplasty to correct the deformity that was preventing him from breathing out of one side of his nose.
I confirmed with our insurance company that Dr. Moynihan was indeed in-network. Our coverage included plastic surgery for cancer, birth defects and trauma. We went for his consultation with Dr. Moynihan and a surgical plan was made. After the exam, we were brought into the office to discuss the financials with Susan. Susan went over the charges for the surgery. She stated what the fees were for the surgery and had us sign the appropriate paperwork stating we were responsible. I stated per the insurance, this would be covered at 100%. Seeing as my husband had met his deductible and was almost to his maximum out of pocket for the year, from all the bills from the accident, we did not expect a significant out of pocket. She stated the insurance didn't always cover their fees and I stated I spoke with the insurance and had confirmed the coverage, so my husband went ahead and signed the paperwork accepting responsibility for payment. We had to pay Dr. Moynihan's $8000.00 fee up front, but were expecting a refund once the claim was submitted and processed by the insurance.
What was not explained to us was Dr. Moynihan charges a premium above and beyond what our insurance covered. We had no idea an in-network physician could have you sign paperwork that waived your rights to insurance. If we understood this fee was a premium that we were solely responsible for, we would have sought care from another plastic surgeon. We chose Dr. Moynihan based on the referral AND because he was an in-network physician. We had paid a significant amount for my husband's emergency bills and, may I add, we pay the full premium for our insurance as my husband is retired so we wanted to make sure he was in-network to minimize our further cost.
What added insult to injury was there were several months between the consultation and the actual surgery due to the nature of my husband's injury. During that time, there were several phone calls back and forth between the insurance, Dr. Moynihan's office staff, and myself. I continued to question the billing and the coverage by the insurance. I continued to say to Dr. Moynihan's staff that his fee would be covered at 100% by the insurance. These conversations gave Dr. Moynihan's staff ample opportunity to clarify that this $8000.00 fee was solely our responsibility and not something they submitted to the insurance, but they never did. These conversations went on until the night before his surgery when I received written authorization from the insurance company for the procedure.
After the surgery, I received the EOB from the insurance. The charge was less than what we paid up front and I mistakenly thought this was due to the surgery taking less time than was originally scheduled. I know OR billing is in 15 minute increments after the first hour. The insurance was billed $6575.28 and the amount covered was $2342.44 with our portion being $234.23. I expected a refund of the $8000 less this amount. To my surprise I was told there would be no refund. In fact, in response to my inquiry I was told. "You asked how insurance coverage would be handled for the $8000 surgeon's fee. I explained that any additional coverage would need to come in the form of a reimbursement after the procedure. You were confident that a significant portion would be covered so I noted again that I have not seen more that $2,000-$3000 total coverage even in the most extreme cases. I also noted that Dr. Moynihan is not the only doctor who performs these procedures and there my be another doctor who could do a decent job within the limitations of insurance coverage." Even in this emailed reply from Susan, you can see the ambiguity of lumping the $8000.00 fee with the $2,000-$3,000 the insurance company would cover. The $2,000-$3,000 coverage was for the amount billed the day of surgery and had nothing to do with the separate $8,000 fee paid up front. Stating the insurance would cover any portion of the $8,000 was completely misleading since this amount was Dr. Moynihan's premium and was not submitted to the insurance.
Never once prior to surgery or even in the above quoted response from Susan after the procedure, was it explained that an in-network physician was not obligated to accept the in-network contract limitations that would limit the fee charged. I found out the hard way the piece of paper my husband signed essentially waived the insurance obligation Dr. Moynihan had as an in-network physician. A little bait and switch for those of us not savvy in the ways of insurance billing, even though he advertises himself as an in-network physician. read more