Fees and Insurance
(Updated 10/25/2011)
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
- Blue Choice
- Blue Cross Blue Shield Federal Employee Plan
- Blue Cross Blue Shield SC *
- Blue Cross Blue Shield State Health Plan (SC)
- United Healthcare
*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 in advance the amount that we estimate that your insurance contract requires.
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: a radiologist, a pathologist and an anesthesiologist. These charges will all be significantly less than my fee.
When estimating 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 and your out-of-pocket maximum for the year? How do all of these fees apply to the yearly out-of-pocket maximum? When does the “year” begin and end according to your plan? Insurance companies have made this process extremely complex.
My fees are fully explained in section IV; however, if I am “in network” for your plan, as described above, a discounted rate will be applicable to you. We can only tell you what this rate is after we see your insurance card.
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