Practice Billing Philosophy: What are my insurance options?

Out-of Network Benefits

In many instances the ACTUAL OUT-of-POCKET EXPENSES may prove to be LESS than if a patient remains "In-Network". While this seems counter-intuitive, it is quite factual. Once our office staff helps you to determine the details of your insurance plan, they can then assist you in working through these financial details. PATIENTS ARE OFTEN VERY PLEASANTLY SURPRISED TO LEARN THAT THEIR PERSONAL FINANCIAL COST IS LESS SINCE WE MAY HAVE CONSIDERABLE MORE LEEWAY TO LOWER THE ACTUAL "OUT-OF-POCKET" COST THAN AN "IN-NETWORK" NEUROSURGEON DOES.

AS OUT-of-NETWORK NEUROSURGEONS, WE ARE NOT CONTRACTUALLY OBLIGATED TO ANY OF THE INSURANCE COMPANIES' RESTRICTIONS THAT AN ORDINARY NEUROSURGEON IS REQUIRED TO IMPOSE ON THE PATIENT. Having this latitude permits us to work with the patient to REMOVE BARRIERS that WOULD ORDINARILY stand in the way of your access to the level of Neurosurgical assistance offered by our Surgeons.

We do not believe that these matters should stand in the way of your access to the types of highly advanced techniques offered by our Surgeons.

Insurance Schemes that Do Not Provide Out-of-Network Benefits include HMO (Health Maintenance Organization), managed care, Medicaid, Medicare and Tricare. Some "private" health insurance plans do not provide out-of-network benefits as well. We urge all patients to verify their "out-of-network" eligibility as indicated in their health insurance policy.

BLUE CROSS BLUE SHIELD OF TEXAS (BCBS)

NEUROSURGICAL CONSULTANTS, pa has made special arrangements to accommodate patients who are covered by BCBS of Texas even though we are not contracted with ANY INSURANCE SCHEMES and are "out-of-network" providers for any and all health insurance companies.

1. ALL BCBS patients will qualify for an INITIAL NO OUT-OF-POCKET COST COMPLETE Neurosurgical Consultation with our Senior Neurosurgical Staff.

2. There will be NO OUT-OF-POCKET COSTS for follow-up visits related to that initial Neurosurgical Consultation.

3. In the event that Neurosurgical Treatment becomes appropriate in your care, we will provide you with an ITEMIZED WRITTEN ESTIMATE OF THE SURGEONS' FEES TOGETHER WITH AN EXPLANATION OF WHAT THOSE SERVICES ENTAIL.

4. Neurosurgical Consultants, pa will offer to BCBS insured patients the same discounted service and guaranteed fixed professional fee for the specific Neurosurgical services as is offered to our Medicare patients.

5. BCBS "Co-pay" and/or "deductibles" will NOT APPLY to any services provided by our Neurological Surgeons.

6. Neurosurgical Consultants, pa will file BCBS insurance claims on behalf of the patient and REFUND to the patient those funds collected on their behalf provided that there is no outstanding balance on their account with our office.

7. Neurosurgical Consultants, pa will assist all BCBS insured patients as they seek to recover additional payments from BCBS and will provide all the relevant medical information and documentation to support that claim.

8. Services provided by the hospital and/or other healthcare professionals are billed to BCBS by those entities according to their specific and separate contracts.

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This page last edited on 2/19