FAQ – Insurance

What insurance companies are in your network?

We are in network with most major insurance companies, including Medicare. You may visit our insurance page for a current list or call our Insurance / Billing Department.

How much will this cost?

We call your insurance company to get benefit information prior to your coming to our office and prior to procedures. We will do our best to give you the closest approximate amount you will need to bring with you. Because this is an approximate amount, there may be an additional amount that is due after services are provided. You should receive a monthly statement for any additional amounts that may be due. If there is any refund due to you, we will issue this amount back to you once you have completed all treatment and all dates of service have been settled out with your insurance company(s).

Why didn’t the large amount I paid on my surgery day cover everything?

  • We bill for each date of service. We do not bill a global fee.
  • The amount we collect prior to your procedure (EVLA) is an ESTIMATE of what your insurance company says is your responsibility for those date(s) of service only.
  • The amount collected will be applied to those date(s) of service.
  • If there is additional money left after the insurance has settled out for those dates of service, we will apply any leftover balance to future dates of service.
  • As you continue through treatment with sclerotherapy, we check benefits and inform you of additional amounts your insurance company says may be your responsibility. These payments are expected on the date of service prior to treatment. These estimated amounts are expected to be paid on the date of service prior to treatment.
  • Because these are estimated amounts, any additional amounts will be billed to you after your insurance pays.
  • We check benefits before your initial visit and ultrasound, before the procedure (EVLA), and before sclerotherapy.

What is a deductible?

The deductible is an amount that has to be paid by you, as the policyholder, before insurance will pay on any date of service. This amount will be collected prior to or on the date of service.

What is out-of-pocket maximum?

Out-of-pocket maximum is the amount that you will need to spend or reach before your insurance company will cover dates of service at 100%.

What is a co-pay? 

Co-pay is the amount that is sometimes shown on the front of your insurance card. It may have one for PCP, one for specialist, one for ER. This amount is usually for office visits, but it is really up to your insurance company as to what they determine to be the patient responsibility.

What is co-insurance? 

Co-insurance is a percentage your insurance company may require you to pay even in addition to your co-pay. The most common are: 70% / 30%, or 80% / 20%, or 85% / 15%, or 90% / 10%. For example, the first percentage, say 70%, is what your insurance company is responsible for and the second percentage, say 30%, is your responsibility as the patient.

Will I have a deductible, out-of-pocket maximum, co-pay, and co-insurance?

It is possible. We will do our best to inform you of your benefits. Your insurance company is the one that determines how much you pay. Due to our contractual agreement with the insurance companies, we have no control over what is the patient responsibility. We will request payment for the amount your insurance company states is your responsibility. We encourage you to call your insurance company and check your benefits.

Why won’t my secondary cover what Medicare doesn’t cover?

Secondary plans, or retirement plans, are different from supplemental and Medicare replacement plans. Because they are a retirement plan, premiums are typically paid by the former employer and not the retiree, or offered to the retiree at a discounted amount. These plans are usually catastrophic plans for devastating illnesses or accidents. They usually don’t cover the additional 20% amount that Medicare doesn’t except in these catastrophic situations. Because this is not considered catastrophic, you may be responsible for the 20% that Medicare doesn’t cover.

Why won’t my insurance company pay? 

We don’t always know. We make every effort possible to get your claim paid for you. This may take some effort on your part as well. You are your best advocate.

Can you check my benefits again?

We check benefits prior to new patient visit, EVLA, and sclerotherapy. If you feel or know that your benefits or the amount of the patient responsibility may have changed prior to your appointment, you will need to provide something in writing when coming to or office. Otherwise, we will expect the payment amount that you were notified of at that date of service. Due to the volume of patients and the time that is required for checking benefits, we cannot recheck benefits over and over again.

What does it mean to have a procedure pre-approved, pre-authorized or pre-determined?

To have a procedure pre-approved, pre-authorized or pre-determined simply means we have verified with your insurance company and they have stated the procedure is an “approved” or covered benefit under your specific insurance plan. This, DOES NOT mean, by any definition, it will be paid in full by your insurance company. You may still, and mostly likely will, have a monetary patient responsibility for an “approved” or covered procedure.

In fact, insurance companies state on letters of approval that the “approval does not guarantee payment”. We have no control over a patient’s individual insurance policy and how it will actually pay since this is an agreement between you and them. We can only tell you what they have told us.

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