Breast Reduction Denial - Stockton, CA

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By far one of the worst experiences I have ever...

By far one of the worst experiences I have ever encountered!

I scheduled a consultation back in feb 2016 to interview Dr. Mabourakh to see if he was a qualified candidate to preform my breast reduction. I paid a $60 consultation fee witch did not bother me at all even though I informed the office I was going through insurance. Upon my arrival I was appalled with the location of his office, dirty location. Dr. Mabourakh seemed like a very pleasant/nice doctor, boy was I wrong. Everything was going well until he found out I was not going to pay cash but was going through my insurance. He excused himself from the room and went to talk to his front office, when he returned he asked me if I had informed his staff about this and of course I did. He then transferred me to his pre-op room and right off the back he told me I charge a $150 fee to submit an authorization, umm ok. I decided to go ahead and pay the fee. He then took pictures of my breast and told me he was going to submit the auth but it was very difficult to get anything approved by my insurance. I decided to ask my PCP and pain management doctor for a letter of recommendation to submit with my auth so the chances of getting approved were greater. Two weeks later after the office manger "Maggie" submitted the auth I rcvd an email from her simply stating the auth was denied. I emailed her back and told her I would appeal the denial, did not hear back from her at all, very professional right. After waiting about 40 days I called my insurance and was informed my appeal was approved, I was so excited, finally my back pain would be gone. I emailed Maggie the approval letter then she emailed me back that she had to show the physician the auth letter because the cpt code description stated "repositioning of the breast". At this point I was upset and gave her a call, I told her she had submitted that cpt code from the beginning the only thing I did was appeal the denial. Meanwhile I had rcvd a statement from the office stating I owed an additional $60 for the consultation, a total of $120 I had to pay out of pocket. I called to discuss my bill but Maggie was on lunch and had to return my call. Never did I rcve a call but I sure did rcve another statement asking me to please pay. I decided to call my insurance to clarify things, to my surprise I only had a copay of $25 not $120 that was stated. I informed Maggie of what was going on and she asked me to email her my EOB. They owed me a refund of $35 but once I emailed her my EOB never again was it brought up. I emailed her once again since I had not heard back from her to see if the doctor would accept the letter, apparently he was on vacation. A week later a rcvd an email from her stating Dr. Mabourakh could not accept the auth letter because it stated this is not a guarantee of payment, another excuse. I have been working in the medical field a little over nine years now and never ever in that period have I seen an authorization state otherwise. I emailed her asking for the physician to give me a call but instead she set up an appointment for me. Keep in mind five months have gone by. After waiting two weeks I finally had my appointment yesterday and wow it so rude and unprofessional. He entered the room with no manners and right of the back told me I can not accept this, I will not get paid , it states this is not a guarantee of payment. I then told him I specialize in billing and have never seen an auth that states otherwise and his quick response was I been doing this 20 + years and I can not do this. I need to get a letter from my insurance that stated they would pay. If a breast reduction was not a covered paid benefit under my plan my insurance would have never authorized the procedure from the start. I told him his Office manager was unprofessional and did not return my emails, he quickly shut me up and responded she is on vacation and she has worked for me for years. He obviously does not see how unprofessional she is, her work reflects on him. Long story short, he is money hungry and only is interested in cash paying. He will find any excuse to refuse you services and is a shitty unprofessional physician.

Rude, unprofessional & money hungry!

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