Complaint Review: Surgery Center Management LLC - Fremont and Beverly Hills California

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The first-step weight loss advertisements are all over the radio stations.  I called the number and was referred to "insurance clearance personnel."  I gave him my name and my insurance company's information.  He called me back and said that I was "pre-cleared for necessary medical weight loss services."  I was hesitant, but he told me about the free consultation in Fremont California so I thought I would check it out. At the consultation I was rushed into a room with a nutritionist who asked me a myriad of questions.  I told her I just wanted to ask some questions about the medical weight loss program.  She brushed me aside and took a bunch of notes about my weight, diet, age, and previous weight loss programs I have been involved in. I then was taken to my consultant, Terri Brown, who told me that I was a great candidate for the lap-band based on my height, weight, and BMI.  She described me as Obese (I wear a size 31 pants...). I told her I was not obese, but that I did want to loose some weight.  She said that based on my insurance plan I needed to undergo some procedures as a requirement by my insurance to make sure I was healthy enough to undergo the lap-band surgery.  Terri said that I needed 2 sleep studies, an endoscopy, and to get on a nutrition plan (hence the nutritionist I just spoke to).  I told her that I needed to check with my insurance company because I am a college student and cannot afford to pay out of pocket.  Terri assured me I was pre-cleared and said she would handle everything. She even knew my deductible! In the mean time she insisted I to get started with the procedures I listed above.  I went in for the 2 sleep studies and the endoscopy.  I asked the nurses before and after if they were sure my insurance covered it.  They all told me I had insurance clearance for the procedures.  At the endoscopy clinic, which was in San Jose, the receptionist gave me a huge stack of papers to sign and told me that I needed to hurry up and sign them otherwise the doctors were going to give up my appointment. The waiting room was very busy.  She gave a quick summary of what the papers meant and briskly told me where to sign.  I never got to read them all the way through myself.  I had an uneasy feeling, but I asked so many times and so many different people about my insurance, I thought if my insurance did not cover it, someone would tell me.  On a follow up appointment after the endoscopy, the doctor (who never even told me her name) informed me that I was pre-diabetic, had high cholesterol (which runs in the family), and had SEVERE sleep apnea.  Upon finding this out, Terri said I needed the lap-band right away and sent a request to my insurance company. I was none of those things, I later found out, and my insurance company flatly denied the request.  Terri told me that the center would appeal it right away and that I needed to continue seeing the nutritionist once a month.  A couple months later my insurance billed me up to $40,000 and says they will not pay the charges for the procedures because it was an out-of-network center.  Terri specifically stated that my insurance company required those procedures to make sure I was healthy enough for the lap band surgery.  I called Jeanette at Surgery Center Management at LLP, after Terri referred me to the billing department.  Jeanette told me that she had my account pulled up and it showed that I did not owe a dime.  She explained that this was just an explanation of benefits and she told me that I was given insurance clearance therefore would not have to pay a dime.  She said that if her company needed to "write it off" they would, but nothing would come out of my pocket.  She started an appeal and I never heard back from her.  I assumed that it was being taken care of.  Fast forward a couple months to yesterday, I receive a bill from Surgery Center Management LLC in a "certified priority mailed envelope" for $4113.60.  It has no date when it needs to be paid by.  I called Jeanette back in a panic and she told me she did not remember me, but she pulled up my account again.  She said that she would talk to her supervisor about "writing it off" but would have to call me back (it was a Friday).  I received no call back so I called again that same day.  Jennifer picked up the phone and when I asked her if Jeanette was available she said, "Yes sure."  I heard her say, "phone for you" and Jeanette replied, "Who is it?"  Jennifer inquired about my name and I told her, "Erika, I talked to Jeanette a couple hours ago."  Without a response I was forwarded to Jeanette's voicemail box.  Now I am stuck with a $4113.60 bill, no date specified when it needs to be paid by, and a billing department that will not take my calls.  To top it off, I called Terri Brown and said, "Hey Terri, this is Erika [last name] I haven't seen you for a couple months and received a very big bill.  I'm not sure how this happened... The person on the phone said, "you must have the wrong number, this is not Terri." The person on the phone sounded JUST LIKE TERRI.  I looked at the contact on my iPhone, which specifically says, "Terri Brown" and asked, "Oh?  Do you have a forwarding number for Terri?"  And the person (who sounds just like Terri) replied "no" and hung up.  The scariest part of this entire debacle is this $4113.60 bill is only a fraction of the $40,000 that they previously billed me for.  I have a feeling I will be receiving more of these certified priority mailed envelopes.  I am a college senior taking 23 units and do not have a job.  I have no way to pay this and no one to talk to about it.  This will most absolutely ruin my credit and drown me in debt.

To sum it all up: I was referred to a surgery center and promised that insurance coverage.  They assured me on numerous occasions I had no financial responsibility other than my deductible.  They then conducted a series of unnecessary procedures that they said were a requirement.  The surgery center than billed my insurance company and I artificially inflated charges.  The surgery center and billing department stopped taking my and did not give me a date the bill needs to be paid by.