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IT IS OUR INVIOLATE POLICY TO PLACE THE WELFARE OF OUR PATIENTS
ABOVE OTHER CONCERNS.
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:
- 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 stress;
- The need for our patients to comprehend these
complexities is essential;
- 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.
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 hospitals.
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 an itemized written
estimate (with explanation) of the costs of the Neurosurgical procedures.
If, for any reason, this has not been provided please request one.
We employ standardized "Procedural Codes" which are in general use
in this country for any of the operations that we conduct.
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 company.
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 care.
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.
AS A GENERAL RULE, WE DO NOT IMPOSE INTEREST CHARGES ON ANY OUTSTANDING
ACCOUNTS provided that the patient is candid and transparent in their
financial commitment regarding the contracted services that we have
provided. In unusual circumstances where the patient has, without
adequate notice, explanation or reasonable effort, failed to meet
their commitment, we reserve the right to impose interest and
carrying fees that are consistent with contemporary commercial
practices. In the rare event that this becomes necessary, the patient
will be informed in writing well in advance of the implementation
of those charges.
WE ARE RELUCTANT TO EMPLOY A "COLLECTION AGENCY"; however, the
unusual circumstances referred to in the preceding paragraph may
also result in our initiating alternative "Collection" methods.
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Neurosurgical Consultants, P.A. does not participate in any
insurance plans. EVEN THOUGH WE ARE NOT PARTICIPANTS IN YOUR
PARTICULAR INSURANCE PLAN, we are pleased to see you in consultation,
help you to fully understand your Neurosurgical condition and determine
the most appropriate course of action for you. We are always willing
to work with you regarding the financial aspects of your Neurosurgical
care.
Most plans allow patients Out-of Network Benefits.
In most cases this will provide our patients adequate
coverage. You may wish to verify our participation 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.
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
CONSIDERABLY 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 level of Neurosurgical assistance offered by
our Surgeons.
HMO (Health Maintenance Organization), managed care, Medicaid and
Medicare plans do not provide out-of-network benefits.
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We are pleased to have the opportunity to provide Neurosurgical
care to Medicare insured patients and have made special accommodations
for them in this practice.
We are not "Medicare providers"; however, this DOES NOT MEAN
THAT WE WILL NOT OR THAT WE CANNOT CONTINUE TO PROVIDE CARE TO MEDICARE
PATIENTS. It does mean that some changes are required by the
Federal Government in order for us to provide that care.
We will share written information with you that explains this new
relationship. While this change (from your usual Medicare
expectations) may appear to cause you some concern at the outset, please
take a few minutes to learn more about this since it may permit
you to enjoy a higher level of care than you otherwise might have access
to.
In addition there are a couple of hidden, pleasant surprises
that go along with this change. The first change that you will notice
and benefit from is that your initial comprehensive Neurosurgical
consultation is free of any charge. Secondly, you may be
eligible for some Federal Income Tax benefits in the event that you come
to require a Neurosurgical operation. (This is explained in a
little more detail below and you will want to consult your tax advisor
regarding this potentiality.)
In the event that a Neurosurgical operation becomes appropriate for
your care, Medicare will continue to cover your costs for
hospitalization (and for any other physicians who do participate) under
Medicare Part A which is the same as for anyone else. There is NO CHANGE
and NO REDUCTION OF BENEFITS.
Another area of "change" relates to a part of your relationship with the
surgeon. In this case both you and the Neurosurgical Consultants'
surgeons are required (by the Federal Government) to enter
into a "Private Agreement" (a "contract") regarding that care.
This means that you and Neurosurgical Consultants must sign a
special form which we will provide to you free of any charge.
The Federal Government absolutely FORBIDS YOU from filing any
additional forms/claims for reimbursement of the costs related to the
"contract" between you and Neurosurgical Consultants.
You cannot file any Medicare or Medi-Gap claims for reimbursement
of our services.
This DOES NOT, IN ANY WAY, AFFECT YOUR MEDICARE COVERAGE FOR ANY
OTHER MEDICARE ELIGIBLE SERVICES or other doctors who continue to
participate in the Medicare program.
The "contract", referred to in the above paragraph, will
have the details of the financial arrangement that is entered into
regarding your Neurosurgical operation. It is this aspect which
may provide you with an additional Federal Income Tax benefit as
mentioned earlier.
Please know that we are sensitive to the financial concerns of all
of our patients and particularly many who are covered by Medicare.
We will make every effort to accommodate your financial situation in
order to lessen the burden that your Neurosurgical problem has placed
upon you.
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This page last edited on 12/11
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