Insurance Participation and Price Transparency
Over the last decade the health insurance industry has become extremely complicated and difficult to understand. We all deal with terms such as ‘In Network’, ‘Out of Network’, ‘Co-insurance’, ‘Deductibles’ and many more. It is important to understand your benefits and how it relates to your surgeon. At Advanced Surgical we have both “IN Network” and “OUT of Network providers”. Our staff will help you understand your benefits and what your financial responsibilities will be.
IN NETWORK Provider
When a Provider is “in network”, it means that the physician has a reimbursement contract with your insurance company. This does not mean that you don’t have any financial responsibilities. Insurance companies have increasingly gotten in the habit of increasing the patients’ financial responsibilities by increasing deductibles and co insurance. So even if you see an “in network” provider you will still be responsible for your insurance deductible and co insurance.
OUT of NETWORK Provider
Often patients think that “out of network” providers don’t participate or don’t take insurance, and that the patient will have to pay the entire bill for services. This is not true and is often a strategy by the insurance company to encourage patients to not use their out of network benefits. An “out of network” provider does not have a reimbursement contract with the insurance company. This usually occurs when the insurance company undercuts the physician with fees that are far below fair market value and often even less than Medicare reimbursements. In those instances, the physician remains “out of network” but still bills the insurance for fees at a fair market value. Price transparency is important to us at Advanced Surgical, that is why all of our fees are based on the Fair Health fee schedules, which is the industry standard. Similar to your “in network” responsibilities, you will also have deductibles and co-insurance that will be assessed by your insurance company.
It is important to understand that we must bill for all deductibles and co-insurance assessed by the insurance company. However, in cases for financial hardship, we are able to discount or write off the amount you may owe out of pocket.
Learn more with our Insurance Glossary