Fees and Insurance
(Updated 5/22/2008)
II. Quick Reference for Insurance Coverage
If I have a contract to provide my services to an insurance company at a discount, I am “in (their) network”, if I do not, I am “out of (their) network”.
Currently I am “in network” for the following plans:
- Aetna PPO
- Beechstreet
- Blue Choice
- Blue Cross Blue Shield Federal Employee Plan
- Blue Cross Blue Shield SC *
- Blue Cross Blue Shield State Health Plan (SC)
- CCN
- Cigna
- Corvel
- Ethix / Southcare
- Evolutions
- First Health
- Guardian Resources
- Plan Administrators (PAI)
- Premier
- Select Health
- United Healthcare
- Wellpath / Coventry
*Most standard Blue Cross/ Blue Shield plans from other states have a reciprocal agreement with Blue Cross of SC and are therefore also “ in network”. We can tell you if this applies to your Blues plan.
The hospital is financially independent from my orthopedic practice; even if I am “out of network”, the hospital may still be “in network” for your insurance plan.
If I am in network for your plan, we will request that you pay any unpaid deductible, $1000 MIT (Minimally invasive Technology) and also the surgical assistant fee (typically $1200) in advance. Some of our contracted insurance companies don’t cover MIT and surgical assistant fees. We will then bill your insurance company according to our agreed upon contract with this insurance company. After your insurance company pays me, we will square up the final bill with you. If they pay a portion of these fees we will refund them to you.
We have a financial counselor who can assist you with any questions.
We can put you in contact with the financial counselor of the hospital, who can give you approximate charges and answer any questions about insurance coverage of the hospital bill. The hospital charges will amount to the largest portion of your final bill, by far.
There will also be much smaller bills from three other professionals involved in your case. These will all be significantly less than my fee:
- Radiologist
- Pathologist
- Anesthesiologist
When trying to come to a final conclusion about the likely final cost of the procedure, you must also consider the conditions of your contract with your insurance company. What is your copay, your percentage responsibility, your out of pocket maximum for the year? How do all of the above fees apply to the yearly out of pocket maximum? When does the “year” begin and end. Insurance companies have made this process extremely complex.
My fees are fully spelled out in section IV E. But if I am “in network” for your plan, as described above, a discounted rate will be applicable to you. We can tell you what this is after we see your insurance card.
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