Costs, Insurance & Payment Information
PAYMENT & ACCOUNT INFORMATION
We accept CareCredit, Visa, Mastercard, Discover, and Cashier’s Checks. No personal checks or cash, please. If you are looking for the CareCredit application, please click HERE.
If you would like to make an online payment on a patient’s account, please click this link to access our secure payment page on the Card Pointe system: PAY HERE
If you are looking for access to your Patient Portal, please click HERE.
If you are looking for insurance and cost information, please read on.
INSURANCE & CARE AT THE CEC
Insurance can be a confusing issue, and there may be significant misunderstanding about how your coverage works with our Center. It is our hope that this information will clarify the basic details; however, should you have any questions, do not hesitate to call us at 770-913-0001 and speak with our dedicated insurance expert.
In the simplest of terms: the CEC is an insurance-friendly, out of network provider. We also have preferred rates for select insurance companies (see below). This means, you are seeking care outside of your insurance company's preferred provider network, as is often the case with many medical specialists. As a result, your insurance may pay for less coverage of services (or not at all), vs. going to one of their “in network providers” - who, while covered, typically do not provide the focused, expert care that we do. This does NOT mean we do not accept insurance - and we are not ‘cash only.’ Our services will process as an out of network practice for those who have surgery with our team. As an out of network provider, we do not accept assignment. We bill the patient up to their out of pocket maximum, which varies by case.
Unlike other out of network providers, however, we do take significant amounts of time to check eligibility and benefits. We will also file a claim on behalf of patients as a courtesy and appeal for coverage after the initial claim has been filed/denied. We also provide other reasonable assistance on a case-by-case basis ranging from letters of medical necessity to peer to peer reviews. We take an active role in helping our patients understand and maximize their insurance coverage - a level of support not typically provided by most out of network practices.
Patients are provided with an estimate of costs, based off their specific surgical plan, and these amounts will be discussed prior to confirming the patient’s surgery date. We will also verify if an authorization is needed and pre-certify our patients as necessary (note, however, that authorization is not a guarantee of payment, and every patient will be asked to bring in a specific payment amount at the time of their pre-op - the amount depends on the specifics of each case).
You should connect with your insurance company directly prior to seeking care with our Center in order to clarify and understand your personal policy, so you will know if you have coverage, what might be covered, what’s not, and to avoid any surprises. Please also remember that each insurance policy is different. For example, Patient A with BCBS and Patient B with BCBS may have totally different claims coverage. You should also be prepared to appeal on your own if our appeal is not successful.
It is extremely important to understand that although you may not have any out of network coverage for our Center, Northside Hospital (which comprises the largest part of the costs) and associated providers may be considered in-network, and you can use your insurance to cover their charges. While we can only speak to our own surgical fees, you can obtain information about the hospital, anesthesia, etc. at: Billing and Insurance | Northside Hospital.
COSTS OF SURGERY
So that patients considering our care have the information they need to make informed decisions, the out of pocket costs of surgery at our Center range between $5,000 to our maximum cost of $21,500. Costs are solely dependent on the type of insurance benefits the patient has and the complexity and length of their case. We do not know what your cost will be before reviewing your case and working up the procedures you need.
Some insurance coverage is better than others and we are able to offer preferred rates to those subscribers. For example:
BCBS, UMR, UHC, Aetna, Cigna, Humana: out of pocket costs typically cap at $5,000.
Self-pay patients and those with plans automatically considered self-pay (Medicaid, Medicare, Tricare, Ambetter, CHAMPVA, Kaiser, Molina, Oscar, Medishare) are also provided a flat rate based on the surgical plan; out of pocket costs range between $11,000-$14,500 maximum.
Please note: the minimum $5,000 fee is not refundable, and the figures above are good faith estimates reflecting typical costs within the $5000-$21,500 range. However, we cannot guarantee that your personal insurance benefits will limit your costs to the discounted amounts shown. Costs are based on individual case complexity and insurance coverage and range between, as stated, $5,000 to our maximum out of pocket cost of $21,500. Your specific out of pocket amount will be communicated to you once your surgery coordination begins. Please also note that travel and lodging are never part of our fee quote. Patients are responsible for their own transportation and accommodation costs. They are also responsible for any supplemental services they may be interested in procuring, e.g., home health aide, etc.
In specific and limited circumstances, we may provide income- and asset-based discounts from time to time to highly qualified patients on a case-specific basis for those who meet strict criteria. Patients may apply once their surgery is scheduled. Application is not a guarantee of qualification, and not everyone will be approved.
More information on “Surprise Billing” and “Balance Billing” from the US Centers for Medicare & Medicaid:
https://www.cms.gov/files/document/nosurpriseactfactsheet-final508.pdf
WHY WE REMAIN OUT OF NETWORK
We are out of network because we a small private practice - not a large academic center or hospital offset by external reimbursement structures and other operating revenues. As a private entity, to stay within carrier contracts, we would be required to reduce the quality of care offered to our patients in order to adhere to utilization management requirements, which we are unwilling to do. We will not compromise the quality of services we offer in order to stay 'in network' with a bureaucracy; participating as an out of network provider allows us to maintain autonomy and ensure the quality of care our patients deserve. We believe your treatment decisions should remain between you and your physician, not an entity that does not understand the need for advanced, multidisciplinary expert care for endometriosis and related surgical gynepathologies.
We remain sensitive to and recognize the lack of access to excision and multidisciplinary care among the endometriosis community, which is why the CEC team has been involved for decades at the national level in efforts to restructure the failed coding and reimbursement system surrounding endometriosis treatments and poor disease guidelines. We are also represented on institutional coding and related committees seeking to make significant changes to formally recognize the subspecialty of endometriosis in order to further remove financial barriers for patients. Of course, we also donate a number of surgeries and work with our patients year-round to increase access to our own Center. For more information, please read on:
Excerpted from "Low payments for excision surgery frustrate physicians, patients" (previously featured on the Endometriosis Journey, a project of MDEdge) by the leading medical writer, Alicia Gallegos: “Similar challenges are playing out in practices across the country as surgeons try to manage the relatively low insurance payments for certain complex endometriosis-related surgeries, as well as the often time–consuming paperwork demands that come with seeking appropriate payments and coverage for patients...A spokeswoman for America's Health Insurance Plans (AHIP) would not comment specifically on coverage for endometriosis excision surgery…The absence of a specific billing code for endometriosis excision contributes significantly to poor payment for the procedure, surgeons said. Currently, excision is generally billed under CPT code 58662, which refers to the destruction or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method. This means that insurers view a full and complex excision of endometriosis as comparable to a superficial ablation procedure, said Ken Sinervo, MD, Medical Director for the Center for Endometriosis Care in Atlanta, which operates on an out-of-network basis. "There's a huge difference between ablating something and excising something," Dr. Sinervo said.”