We have an agency that will be able to work with you to contact your insurance plan regarding the processing of your claims for proper payment and patient responsibility. However, it is very important that you stay involved in the process through the resolution on your claim(s). Regardless of our network participation, you may be able to request your plan pay us directly. It may also be required that you sign a form at your office visit giving us permission to appeal the insurance decision on your behalf. If you have or do receive payment from your insurance company, it is imperative that you submit that payment to us as soon as possible.
1. You arrive at the ER where one of our surgeons is called in for a consult.
2. Our Surgeon performs a consultation and discusses a treatment plan, which may include surgery and follow up care.
3. The procedure is performed.
4. The surgeon’s billing office submits a claim to your insurance plan on file with the hospital.
5. The claim is processed but may determine that a large part (or all) of the charges are patient responsibility, in error OR
6. The insurance plan may process your claim and pay you directly. You will need to submit that payment and any supporting explanation of benefits to the surgeon’s billing office quickly.
7. Depending on the various state guidelines, you may be asked to sign a form for us to appeal the insurance plan decision on your behalf or you may receive a statement in the mail that encourages you to contact the insurance to reprocess your claim as urgent and emergent in nature.
8. The insurance may reprocess or call the surgeon’s billing office for more information after you contact them. (See Billing FAQ’s for additional information.)
9. You may receive a final statement showing your co-insurance or deductible due.
We’re here to help
Since our inception, our mission has always been to find the best surgeons to provide high-quality emergent and urgent surgical care.
With the help of Inpatient Care Management, we can help guide you through what comes after.