Understanding Your Out-of-Network Benefits

Understanding Your Out-of-Network Benefits

SurgiCare of Manhattan was founded by physicians with a common passion: to deliver the most advanced and technologically up-to-date surgical care in a stress-free environment.  Our commitment to quality of care and its compassionate delivery to you require that we remain free from the restraints that in-network insurance policies can place on your doctor when deciding your treatment plan.  Insurance carriers refer to SurgiCare of Manhattan as an out-of-network facility.  We are not alone as many high quality specialty centers and hospitals have made the same choice as SurgiCare of Manhattan.
This does not mean that we do not accept your insurance, but rather, it means that we do not currently have a contract with your health insurance provider.  However, if you have an insurance policy with out-of-network benefits (i.e., a PPO policy), you have the additional benefit of visiting physicians and surgical facilities that are outside of your insurance carrier’s network.

What are the benefits of going to an out-of-network facility such as SurgiCare of Manhattan?

Many individuals and their families choose a more comprehensive health insurance policy because it provides more flexibility and freedom to make optimal healthcare choices as compared to strict HMO policies.  The extra premium you are paying for your healthcare insurance grants you and your dependents greater freedom of choice.

Your surgeon has recommended SurgiCare of Manhattan as your surgical facility because the care you need is ideally suited as an outpatient procedure, rather than a more complex and lengthy hospital stay, and also because we have the essential supplies, most advanced equipment, and experienced staff to treat your condition and get you back on your feet as soon as possible.  These resources may not be available at your insurance carrier’s in-network facilities.
Moreover, SurgiCare of Manhattan chooses to stay out-of-network with insurance companies to maintain its own flexibility in optimizing your treatment.  By remaining out-of-network, SurgiCare of Manhattan can tailor its administration to best suit its surgeons and, more importantly, our patients.
In contrast, in-network facilities and hospitals are contractually obligated to adhere to the HMOs’ stringent rules regarding where, when, and by whom a surgery is authorized to be performed – sometimes right down to the specifics of how a particular procedure can be performed!

What kind of bills and statements can I expect from my visit to SurgiCare of Manhattan?

After your surgery you will receive a statement called an Explanation of Benefits (EOB) from your insurance company.  It itemizes the fees charged and indicates the allowable amount covered by your insurance company.  After receiving the EOB, you will receive bills from SurgiCare of Manhattan, your surgeon, and your anesthesiologist for your rendered care.
When you receive the bill from SurgiCare of Manhattan, we strongly recommend that you call us at (201) 834-1120.  Our billing staff will help you to understand your billing statement and will clearly explain how these costs are derived.  We realize medical billing and insurance statements can be difficult to understand and can be very intimidating.  Our billing department will review with you the charges and reimbursements.  Most importantly, we will assist in maximizing your insurance company payment to you for your healthcare costs.

What if I have concerns paying the bill?

In the event that you have difficulty paying your bills, our billing staff will assist you with any financial arrangements necessary to lessen your burden.  They are equipped to offer a wide range of payment options and financial assistance resources.  SurgiCare of Manhattan is committed to make your choice to have surgery in our facility as painless as possible.  We don’t want financial issues getting in the way of your recovery.  For any questions or concerns regarding SurgiCare of Manhattan and your surgery bills, please call us at (201) 834-1120.