I don’t believe this.
This morning I received a phone call from the plastic surgeon’s office. The surgeon himself is away at the annual American Burn Association convention in San Antonio, Texas, and the call was from his practice manager. Apparently, because the workers’ comp insurer would only authorize paying 70% of his fee instead of the “usual and customary” 80%, he will likely not do the procedure I’m scheduled for a week from this Monday.
Whether they realize it or not, they have put me in a very difficult position.
What kills me is that the fee he charges for this procedure, from what I’ve been told, is in the neighborhood of $4800.00. The fee schedule from the Massachusetts Department of Industrial Accidents (the “DIA”), between harvesting donor tissue and transferring it onto the wound, is approximately $1000.00. And 70% of his fee is approximately $3500.00. So even though he wouldn’t be paid what he is asking (in the neighborhood of $3900-4000.00), there is only a difference of about $500 that his office is fighting over with the workers’ comp people.
To me, that seems pretty ridiculous.
My friend Karen suggested to that the concept of professional courtesy is still alive and well and I should consider approaching that with him. I am willing to do that, but if I’m told flat out that it isn’t an option, I have to pursue other remedies. The most radical is finding another surgeon to do the procedure. Another is to file a complaint with whatever organization handles problems like this. After all, I don’t believe that once he accepted me as a patient under these circumstances he could refuse to do the procedure. And it isn’t like he’d be doing it for free or at a Medicare/Medicaid rate; he would be receiving considerably more than what DIA prescribes.
Just the same, this is something I really don’t need. I don’t want to be put in the position of having to start this process all over again, and if this happens it will put me out even further, in terms of getting back to work.
Let’s hope the ideas put in front of me are successful. Otherwise I could be in a whole lot of trouble.