INSURANCE CARRIERS, FEES, AND ESTIMATED EXPENSE:
In regard to medical insurance, our patients fall into one of three categories outlined below. Please also be sure to read and understand the financial policy located in this packet. It will require your initials and signature prior to being seen in our office.
Dr. Williams participates with Blue Cross and Blue Shield. For patients with BCBS, the office will submit your bills to your insurance company for reimbursement. You will be responsible for your copay/deductible at the time of your appointment. In the event that surgery is planned, surgical co-pay/deductible is due prior to your scheduled surgery.
OUT-OF-NETWORK and MEDICARE
So that we may focus our efforts on your care, Dr. Williams is an opt-out Medicare provider. Medicare patients are treated under private contracts only. This means that Medicare patients are unable to obtain reimbursement from Medicare and should therefore consider Dr. Williams' fee an out-of-pocket expense.
Similarly, if Dr. Williams does not participate with your insurance carrier, you are also responsible for the full office visit fee. If you attempt to negotiate with your insurance company to obtain coverage for your visit, the full payment is still due and payable at the time of your consultation. Some patients are able to obtain in-network reimbursement rates for Dr. Williams’ services because their insurance company does not have another physician in-network to provide these services. In this case, full payment for services is still required. The matter of reimbursement rates is between you and your insurance company. As payment, the office accepts cash, check, MasterCard and VISA
The new patient office consultation fee ranges from $350 to $550, depending on the complexity of the office visit. Additional diagnostic testing may be necessary, including nerve blocks and/or in-office
sensory testing. Nerve blocks range from $100-$700 and sensory testing from $75-$600. Depending on each individual’s needs, the total cost of a typical new patient visit can range from $550 to $1,200. Other diagnostic tests or lab work that may be needed can be performed at outside facilities participating with Medicare or your commercial insurance carrier. These will be billed and submitted to your insurance by that facility.
Dr. Williams does charge a fee for filling out various forms, such as FMLA forms, Disability forms, Medicare forms, or preparation of special letters for lawyers or other. The cost of these forms depends on the complexity and time required to complete them and ranges from $25 - $250.
Additional information for our Medicare Patients:
If you carry secondary insurance through a commercial provider (for example, Blue Cross and Blue Shield, United Healthcare, Aetna, Cigna, or other), you may be eligible for benefits under this policy. It is your responsibility to contact your secondary insurance carrier and clarify any benefits. It is also your responsibility to apply for and manage your application for reimbursement. This office does not submit or manage claims to secondary insurance companies. You are advised to seek information regarding secondary coverage in advance of your first appointment. If needed, the office will provide you with an itemized receipt and any medical records necessary for you to apply for coverage under your secondary policy.
Additional information for our out-of-network patients:
The office will provide you with an itemized receipt, including diagnosis and procedure codes that will be needed to apply for reimbursement. If your insurance company requires any other documents or consult notes, we will be happy to provide you with them. You may, in turn, submit these forms to your insurance carrier for reimbursement. Per office policy, submission for out-of-network reimbursement is the patient’s responsibility after the consultation. Any reimbursement provided by the insurance company will be sent directly to you.
It is highly recommended that you contact your insurance carrier in advance of this appointment and advise them that you are seeing Dr. Williams for a consult. Ask them to clarify how reimbursement can be obtained for Dr. Williams’ services and at what rate. Be sure to ask what forms they require and obtain them so you can review them in advance. It may be beneficial to inform them that you have determined that they do not have an in-network provider that you can see for this issue, and further you are requesting that they consider Dr. Williams' consult fees and reimburse you according to in-network rates. Please be aware that reimbursement rates are widely varied.
In the event that a surgical procedure is indicated and agreed to between the parties, there are 3 separate and distinct bills generated by the 3 different entities providing your surgical services:
Dr. Williams’ surgical (professional) fee.
Facility Fees (i.e., operating room, circulating and scrub nurses, pre and post-surgical services, and supplies) - submitted directly to Medicare or insurance by the facility (Timonium Surgery Center or GBMC)
Anesthesia fees - submitted directly to Medicare or insurance for anesthesia services.
Only Dr. Williams’ surgical fee is paid in full by patients who are out-of-network or on Medicare. (In-network patients will pay the co-pay/deductible determined by their insurance company). The other fees will be billed and submitted to Medicare or your insurance company by the facility’s staff. If you have questions regarding surgical procedures, costs, and billing, they can be best answered after your consultation, when your diagnosis and proposed treatment have been determined by Dr. Williams.
Thank you for giving your time and attention to this packet. You may choose to print and hand-write your answers or complete your forms digitally. Open the packet using an Adobe reader and use the “fill and sign” feature to type directly on the forms. Email between two Gmail accounts is encrypted, therefore your private medical data will be protected.
Feel free to contact the office if we may further assist you. We look forward to meeting you.
The Office of Dr. Eric H. Willams, MD