Out-of-Network Policy
Our policy regarding billing patients for “out-of-network” surgeries is based on two central principles:
Providing certainty to the patient
Ensuring collection by the surgery center.
Your insurance carrier might refer to our surgery center as an “out-of-network” facility. This does not mean that we do not accept your insurance, but it does mean we do not currently have a contract with your particular health insurer. However, if you have an insurance policy with out-of-network benefits (e.g., a PPO policy), you have the additional benefit of visiting physicians and surgical facilities that are outside of your insurance carrier’s network, such as our surgery center.
We choose to stay out-of-network with certain insurance companies to maintain flexibility in optimizing your treatment. By staying out-of-network, we can tailor our processes to suit our surgeons, the surgeries performed here, and, most importantly, our patients. We are pleased to enter into contracts with insurance companies if it is in the best interests of the surgery center’s patients and medical staff. Of course, contracted rates need to match or exceed our competition’s pricing in the marketplace. (We generally consider our competition to be the local hospital outpatient departments.)
Our surgery center may choose to remain out-of-network with a specific insurance company because the insurance company cannot or will not offer contracted rates that compare well with those of our competitors. However, we do not want our patients to be financially harmed by our status as an out-of-network provider. For that reason, in determining what to charge a patient who has out-of-network insurance, we try to adjust the patient’s portion of the payment to compare to what the patient might pay in-network. We are able to provide these discounts because we collect at least 50% of the payment on or before the date of service. This comes at a risk to us, since we agree to perform the services without knowing what the insurance company will ultimately pay us.
So, if you are a patient with out-of-network insurance benefits, in most circumstances* we can offer you the following at our surgery center:
The certainty of knowing, before your surgery, what you will pay;
A discounted cost to you that is reasonably based upon your in-network benefits – so long as you pay at least 50% of that amount on or before your surgery date; and
The assurance that if you pay 100% on your surgery date, you will never receive another bill from us.
This policy is based upon both our concern for patients’ best interests and our need to make sound business decisions. First, we consider our relationships with our patients to be the highest priority. We endeavor to give our patients assurances about the amount they will owe when they come for service at our surgery centers. Navigating the insurance process is daunting and confusing, and we are committed to helping our patients avoid the stress of these unknowns.
Additionally, we understand that when patients are billed for medical care after they receive service, they are 50% less likely to pay their responsibility. Therefore, we offer incentives for the patient to pay before, or on, the date the patient receives service, which increases the likelihood of receiving payment and reduces the overall cost of health care by eliminating the need for collections and follow-up with the patient.
We are happy to answer any questions you may have. Please call the MedBridge Patient Services Department at 855-633-2743 M-F 8am-5pm. This is a toll-free number, so it won’t cost you anything to call.
*To be eligible, you must be insured, in good standing with your insurance carrier, and your claim must not be denied. Other exceptions may apply.