Call your surgeon's office. First, ask to speak to his nurse. Ask for your surgeon's diagnosis, whether your procedure will require radiology/imaging or lab tests.
Physicians
apply for surgical privileges at specific facilities: not every
physician may have privileges at every facility. Ask at what
facilities your physician can perform surgical procedures.
If
you are having total joint surgery, the cost of implants will be billed
by the surgery center. However, you should ask your physician
specifically which implant he/she recommends.
Next, ask to speak to an insurance specialist.
Be patient -- it may take time to check your file and get back to you
with answers and information. Ask for the CPT code(s) for the surgical
procedure your physician has recommended. Note: we've given you space
for four CPT codes -- there may be more or fewer. You will use these
same CPT codes when you talk to your insurance carrier.
CPT
(Current Procedural Terminology) codes are numbers assigned to every
task and service a medical practitioner may provide to a patient
including medical, surgical and diagnostic services and are established
by the American Medical Association (AMA). Insurers use them to
determine the amount of reimbursement allowed. Everyone uses the same
codes to mean the same thing to ensure uniformity. This is how you can
compare costs at different facilities.
If you have any problems obtaining this information, we can help! Just call us.
Remember,
if you're having laboratory tests, you’ll want to compare the costs of
these as well. Ask your physician's nurse or insurance specialist.
Step 2: Information from your insurance carrier
Contact
your insurer. You may be able to obtain this information from their
website or a handbook. You may need to ask your employer's Human
Resource Manager to assist you. Insurance plans vary considerably. Some
don’t cover particular services at all. This is why you need to gather
this background information before you talk to them. Have your
insurance card ready, also.
Find out your deductible -- your
annual amount and what you’ve paid to date, co-insurance and
out-of-pocket -- what you’ve paid to date and the annual limit. The
reimbursement in-network providers receive from your insurance company
is pre-negotiated -- they have established a "contract allowable" rate
for specific medical services.
Contact us to complete this evaluation*.
Obviously,
this is not a simple process. It's easy to miss something. To make
sure you understand what will happen and what it will cost, schedule a
free consultation (and bring your worksheet and a copy of your
insurance card):
• Call us and speak to our administrative assistant 920.683.1250, OR
• Check with your HR dept. for times we may have scheduled at your work site.
We'll
help in completing this process, making sure you haven’t missed any
anticipated charges and double-checking your worksheet and calculating
your total cost. We can also help you compare several providers and
both in- and out-of-network options.
Additionally, your employer
may offer you some rewards for the time and effort you’ve spent in
researching the best value in your health care. Be sure to ask about
this!
We believe an informed patient is the best patient. We
believe it's our job to help you understand and make the best possible
choice. If it turns out that your choice is not our facility, we
believe we will have learned from this process, too. We're here for you!
*
This worksheet is not a formal quote on the cost of medical services,
but intended as an aid to educate and assist consumers in gathering
data about the anticipated costs of their surgery. Call us and we can
help you check your data and provide you with a quote for the cost of
your procedure.
