It is our INVIOLATE POLICY TO PLACE THE WELFARE OF OUR PATIENTS ABOVE
We are SENSITIVE TO THE FINANCIAL CONCERNS OF OUR PATIENTS and will
make every effort to accommodate their financial situation in order to lessen
the burden that their Neurosurgical problem has placed upon them.
We understand that:
Even though we are not participants in any Government (Medicare/Medicaid)
or commercial insurance plans, we will work diligently to determine the
requirements of your particular insurance company recognizing that "plans" vary
from one to the other. Our staff members are familiar with and manage these matters
for you to the extent that this is possible. Our staff will automatically
"pre-certify" your Neuroimaging investigations as well as your operation
with your health insurance company. They are familiar with the
terminology and unique "coding" requirements of insurance companies and
- The practice of Neurosurgery along with the associated technologies,
medications and procedures have become considerably more sophisticated which
can make it more difficult for patients to understand;
- The complexities of the entire health care system have evolved into
one that many patients view as unfathomable;
- Our patients are feeling most vulnerable when a Neurological
illness has beset them;
- Dealing with a major Neurological problem that warrants Neurosurgical
intervention is stressful;
- Having to comprehend and manage an insurance company's rules
and regulations can be daunting;
- Identifying financial responsibility for co-payments or
out-of-pocket expenses as well as understanding a hospital's demands for
financial disclosure and guarantees of responsibility can add to this
- The need for our patients to comprehend these complexities
- At a time when one is concerned for one's life and Neurological
integrity, these additional issues can become overwhelming;
- Getting the most competent Neurosurgeon to care for you may not
be geographically or financially convenient for you or your family;
- For many Brain and Spine surgery patients, the first surgical
treatment is the most important one. It may well determine the quality
of your existence for the rest of your life;
- This may be one of the most important choices that you will
ever make in your life.
It is imperative that we have the correct information from you regarding you
insurance plan and the healthcare coverage that plan provides to you.
Our Business Office will provide you with a written estimate of the costs
of the Neurosurgical procedures. This "estimate" will also include our commitment
to you regarding the ABSOLUTE MAXIMUM "out-of-pocket" expense that you would
ever be responsible for even if your insurance company fails to pay anything.
This "out-of-pocket" guaranteed price is always at a considerable discount
compared to the customary fee. We employ standardized "Procedural Codes" which
are in general use in this country for any of the operations that we
Most plans allow patients Out-of Network Benefits. In most cases
this will provide our patients adequate coverage. You may wish to
verify the parameters of your out-of-network benefits with your particular plan
before you come in for an appointment. However, we would not permit this to stand
in the way of your consultation should you desire one. Our professional assistants
are experts in assisting patients with various health insurance issues. Please
feel confident in discussing your concerns with them.
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
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 level of Neurosurgical assistance offered by our Surgeons.
In addition your Neurosurgeon will, on occasion, be required to ACT AS YOUR
Patient Advocate. This may require
us to write to the insurance company, government agency or your attorney on
your behalf. While you are in the hospital, your Neurosurgeon may need to
support your need for a higher level of nursing care, special treatments, access
to specialized equipment and a longer stay than is ordinarily underwritten by the
insurance company (or Medicare.) These are added duties which we accept as part
of our responsibility to you.
For any portion of your care that is not covered by your insurance plan you
may use your personal check, Visa, MasterCard, or American Express. As the
patient, you are ultimately responsible for payment for the care rendered. We
appreciate your consideration in making payment at time of service.
Unfortunately (and very importantly) there are limitations that the
Neurosurgeon and the office staff are working under when it comes to your insurance
company. Since you, another family member or an employer made a choice regarding
the actual insurance company contracted with, the extent of coverage purchased on
your behalf may have significant monetary, as well as procedural limitations.
This may mean that some Neuroimaging and/or Operations, even though they are
clearly medically indicated, may not be covered. Our office may be able to assist
you in identifying these parameters; however, we have no capability to change
those limitations on your behalf. This contract is between you and that
WE ARE NOT ABLE TO PROSPECTIVELY IDENTIFY THE ACTUAL REIMBURSEMENT THAT
MAY BE FORTHCOMING FROM YOUR INSURANCE COMPANY FOR ANY SURGICAL PROCEDURES SINCE
YOUR INSURANCE WILL NOT DISCLOSE THOSE TO US. UNFORTUNATELY, IN OUR EXPERIENCE,
THEY RARELY EVER DISCLOSE THIS TO THE PATIENT AS WELL.
DO NOT LET THE INSURANCE COMPANY DETERMINE WHO YOUR NEUROSURGEON WILL BE.
For many patients this is a matter of FIGHTING FOR YOUR LIFE. It is
imperative to recognize that health insurance organizations are generally
in the business of making a profit which frequently means limiting
their financial exposure and limiting your access to higher levels of medical
COST SHOULD NOT STAND IN YOUR WAY. You need the best, not the least
expensive Neurosurgeon available.
OUR TEAM IS WILLING TO WORK WITH YOU TO MAKE THE TREATMENT THAT YOU NEED
AVAILABLE TO YOU. We do not believe that financial issues should be the
primary limiting factor impeding your access to the level of Neurosurgical
assistance offered by our Surgeons.
WE UNDERSTAND AND ARE SENSITIVE TO THE FINANCIAL ISSUES THAT FACE OUR PATIENTS.
Under certain circumstances, we will discount our fees in order to assure that
you have access to the care that you seek. Our staff will work with you to
arrange a payment plan and terms that will suit your needs. We encourage
you to speak to a representative from our Business Office.
BLUE CROSS-BLUE SHIELD of TEXAS (BCBS) has instituted a physician payment
scheme that ranks among the most restrictive in the USA. BCBS has chosen to pay
"participating" (contracting) physicians at rates comparable to or lower than
the already bottom-basement Medicare price schedules. This has resulted in
several hospitals and multiple physicians/physician practice groups taking the
drastic step to disassociate from BCBS. Patients who have used those physicians
and/or hospitals must now find other facilities.|
NEUROSURGICAL CONSULTANTS, pa has made special arrangements to accommodate
patients who are covered by BCBS of Texas.
- ALL BCBS patients will qualify for an initial NO OUT-OF-POCKET
COST and FULL Neurosurgical Consultation with our Senior Neurosurgical
- There will be NO OUT-OF-POCKET COSTS for follow-up visits related
to that initial consultation.
- Neurosurgical Consultants will offer the same discount service and
terms to BCBS insured patients as is offered to our Medicare patients.
- 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.
- 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
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This page last edited on 2/19