Understanding Insurance as it Relates to Your Care & Treatment at the CEC

Click here for SPANISH version.

Insurance can be a confusing issue, and there may be a bit of misconception related to insurance coverage and how it works here at our Center.  It is our hope that this information will clarify how we deal with insurance; however, should you ever have any questions at all, do not hesitate to call upon us for help!

First, the CEC is what is referred to as an “Out of Network Provider,” much like many other specialty disciplines in medicine.  This DOES NOT mean that we DO NOT accept insurance; but rather - as with most specialists from all areas of healthcare - we simply are not contracted with any health insurance plans.  We do this to ensure that the care of our patients is not dictated (who we can treat, with what equipment, via what surgical method, and for how many hours in the operating room, for example) by an insurance company that does not understand the meticulous and specialized care that Endometriosis requires.

Seeing an Out of Network Provider simply means that you are seeking care outside of your insurance company's preferred Provider network; as such, they may sometimes pay for less coverage of related services, versus going to an “In Network Provider” (who, while covered, may not be able to provide the focused and expert care for Endometriosis that we do).

Unlike many other Out of Network providers, however, we WILL help you gain a common understanding of charges and payments that may be necessary for you to have the best possible experience at the CEC.  No one wants surprises, so we do as much financial processing up front FOR you as we possibly can, and keep you informed every step of the way.  We will help you file for coverage/reimbursement, assist you with appeals, provide you with letters of medical necessity as appropriate, and provide any other assistance required on a case by case basis in order to make your experience a smooth one and help you garner the maximum benefits from your coverage.  Such service is just one more way that the CEC tries to help our patients.

First Check: Do you have Insurance, and if so, Does it Provide Out of Network Coverage?

When you send your records in for our FREE evaluation and review, we encourage you to send your insurance information as well in your records package.  Make a clear copy of the front and back of the card (you might need to enlarge it for legibility). Send your name, date of birth, and social security number, and the name, date of birth and social security number of the cardholder, if it isn't you (your spouse, parent, etc.). This information will let us get some idea of your coverage levels.  You can also call your insurance company directly before even sending your records to us and find out what they offer for Out of Network services.

At the Time of Surgery: What will be Covered?

If and when surgery is scheduled, CEC staff will check with your insurance carrier as a courtesy to you.  They will also pre-certify you, if necessary, for your surgery.  If your coverage is not 100%, you will be asked to bring in some form of payment at the time of your pre-op.  However, if it is not possible for you to bring in the agreed-upon payment, please call us as soon as you can, so we can work out a payment schedule with you.

If you are a self-pay patient without any coverage whatsoever, let us know that as well right up front.