Financial Responsibility – What Should I expect?

EOSC recognizes that healthcare expenditures have skyrocketed with more and more financial responsibility being shifted to the patient. Premiums, deductibles and co-pays have all gone up significantly in recent years. We strive to take as much stress out of having a procedure or surgery by being transparent and providing patients with their expected financial responsibility for the facility fee portion of their visit in advance of the surgery. A conscious effort is made to notify patients at least several days in advance of any co-pays and deductibles that will be due on the day of the procedure.

A few additional important points will help patients better understand the financial component of their surgery center visit:

• Facility fees charged by EOSC are SEPARATE from the professional fees charged by your treating physician and anesthesiologist.
• If applicable, there may be SEPARATE charges for pathology, lab and/or x-ray services.

An explanation of benefits (EOB) provided to you by your insurance company is NOT a bill for you, but rather an explanation of charges billed.

In-Network vs. Out of Network – What Does This Mean?

Although EOSC is in-network with Medicare and a few HMOs we have decided to remain out of network with most PPO plans. HOWEVER, this does not mean that you cannot be treated at EOSC or will pay more for our services:

• Patients and employers pay large amounts for insurance premiums and often out of network benefits are an included component of these high premiums. This allows patients to exercise their right to be treated at an out of network facility.

• EOSC is committed to being transparent and letting you know what your financial responsibility will be PRIOR to your procedure.

• Many in-network surgery centers and hospitals may collect a co-pay on the day of service or quote an “estimate” of a patient’s financial responsibility. HOWEVER, sticker shock often occurs weeks or months after a procedure once their claim has been adjudicated by their insurance carrier and the patient’s true financial responsibility has been determined per a bill they receive in the mail. There is no way to accurately determine this amount in advance by in-network centers or hospitals as the ultimate procedure done by the physician may dictate codes known as CPT codes which change the charges and ultimate patient responsibility.
  
  

Why is EOSC out of network with my insurance plan?

• EOSC is committed to provide the most outstanding, high quality and state of the art care to our patients. We are not your “run of the mill” surgery center and will not settle for anything less than our patients receiving the BEST care on every level. Often, in-network contracts do not provide a situation of reimbursement which allows delivery of the highest quality of care. Therefore, we determine the patients’ financial responsibility in advance. After collecting the determined co-pay and deductibles the onus of responsibility rests with EOSC to collect from the insurance carrier. We find this model is a win-win for the patient and EOSC.