Why is USA Spine Care Out of Network?
Just because USA Spine Care is out of network with some insurance providers doesn’t always mean you’re out of luck when it comes to getting your procedure covered. In fact, many patients are surprised to know the level of coverage they do have for the cost of neck or back surgery at USA Spine Care.
Many potential patients are pleased to learn that being out of network doesn’t mean USA Spine Care’s services are not covered. What it does mean, however, is the services are not covered at a contracted rate. That’s why it’s best to talk with one of our dedicated Patient Empowerment Consultants to discuss the specifics of your individual plan. Subject to credit approval, we can also provide you with financing options for spinal surgery during this call.
Medical Billing Process
Helping you understand how USA Spine Care works with your insurance plan will help you know what to expect when it comes to our medical billing process. We will begin working with your insurance provider before your procedure. That’s when we’ll verify your plan’s benefits to determine your up-front cost or prepayment for surgery.
After all services have been rendered, we will submit your claims for you to your insurance provider. This includes, but is not limited to: claims for surgery, diagnostics, radiological services, and the lab work you received. Your insurance plan will then determine the allowable rates for the services we provided and apply those rates to calculate your copay, deductible and/or coinsurance (also known as your “Patient Responsibility”).
If your Patient Responsibility exceeds the amount you prepaid for surgery, your insurance mandates USA Spine Care to issue you a statement for the remaining balance.
In the event you do receive a statement from USA Spine Care, please review our billing process for more information. You may also call 1-866-249-1627, extension 8956 and speak with a representative will go over your statement with you and offer payment options to help make your surgery costs more affordable.
Secondary Insurance
Having more than one insurance for spinal surgery is more common than most people even realize. This additional level of coverage, called secondary insurance, can often be very effective in reducing out-of-pocket costs for your care. Here’s how it works: After surgery, and once all claims have been processed through your primary insurance, your secondary insurance will be applied to any remaining balance.
If you receive a statement from USA Spine Care and believe your secondary insurance has not yet been billed, please call us at 1-866-249-1627, extension 8956. Our caring team of professionals will help you determine how your spine surgery insurance was processed.
Medicare Coverage
Are you or someone you care about covered by Medicare or a Medicare replacement plan? If so, it could help with the cost of your spine surgery.
USA Spine Care’s services are covered by Medicare and Medicare replacement plans but only partially. What this means is we bill our services in two portions: professional fees and facility fees. Since Medicare will only cover the costs associated with our professional fees (for doctors, medical professionals and the procedure you received), USA Spine Care will bill Medicare for these costs. Most often this is covered in an 80/20 fashion for standard Medicare plans, meaning Medicare pays 80 percent of the fee schedule for professional fees and the patient pays the remaining 20 percent. If the patient also has a secondary insurance plan, a claim for the remaining 20 percent will be filed with the supplementary plan.
Because USA Spine Care’s ambulatory surgical centers are not enrolled with Medicare, we cannot bill those facility fees through Medicare. To find out more about your specific plan or, subject to credit approval, learn about financing options for back surgery, we encourage you to talk with one of our dedicated Patient Empowerment Consultants.
In Network Insurance
Did you know USA Spine Care is in network with several insurance carriers? We work with potential patients to determine what the insurance plan will help pay for with regard to their minimally invasive spine procedure. Because each plan is unique and your coverage can vary, we encourage you to contact a dedicated Patient Empowerment Consultant to discuss the details of your unique plan and coverage.
