Initial Consultations

If you are evaluated by a physician or physician assistant in one of our offices for an initial consultation, charges incurred cover the time required to obtain a history, your physical examination, review of X-rays, MRIs, and CT scans, review of laboratory studies, review of previous medical records, discussion of your diagnosis and treatment plan, and preparation of a detailed written report which will be sent to your referring physician.

You must be referred by another physician for an initial consultation.

Insurance co-payments are due at the time of your visit.

Office Visit

An office visit is exactly the same as a consultation, except a physician referral is not necessarily needed.

Our practice is a specialty practice that works almost exclusively on a referral basis, so this type of charge is not commonly used.

Follow-up Visits

Subsequent or follow-up visits are typically briefer and have a lower fee than initial consultations.

Insurance co-payments are due at the time of your visit.

Hospital Care

If you receive non-surgical care in a hospital setting, charges apply for initial consultation and for hospital visits on subsequent days, similar to those described above for the outpatient setting.

Insurance co-payments are NOT required for inpatient services.

Surgical Care

If you undergo a surgical procedure with one of our surgeons, charges are typically billed as a “global fee,” which covers the surgeon’s fee for the surgical procedure, as well as all subsequent inpatient and outpatient care for a “global period” of 90 days after the procedure. (Global period is shorter for some minor procedures).

The fees paid to The Neurosurgery Group specifically DO NOT include fees for the hospital, anesthesia services, operating room time, X-ray CT and MRI interpretation by a radiologist, and other hospital charges which are billed separately.

Information for Patients with Insurance

The Neurosurgery Group of Western Pennsylvania participates with the following insurance plans:

• Highmark Blue Cross Blue Shield (all traditional plans) including
  • Federal Employees Program
  • Premier Blue
  • Special Care
• Highmark Blue Cross Blue Shield HMO products including
  • Keystone Blue
  • Select Blue
  • Community Blue
  • Direct Blue
  • PPO (Preferred) Blue
• Highmark Blue Cross Blue Shield Medicare HMO products including
  • Security Blue
  • Freedom Blue
• Blue Cross Blue Shield of Ohio (Anthem)
• UPMC Health Plan
  • UPMC for You (Medicaid)
• HealthAmerica including
  • Health Assurance
  • Advantra
  • Care Link
• Aetna/US Healthcare
• Medicare
• Gateway
• AmeriHealth
• Beech Street (Intergroup)
• Corvel
• Cigna
• Devon
  • Megan Insurance
  • Pennsylvania Public School Healthcare Trust
• First Health Network
• Flora Health Network
• Focus Health Management
• Ohio Bureau Workers' Compensation
• Ohio Medicaid
• Pensylvania Medicaid
• Private Healthcare Systems (PHCS)
  • Alpha Health Network
  • Mailhandlers
  • Medical Mutual
• Procura
• QRS (School Claims Service)
• Railroad Medicare
• Tricare (Federal Government and Military)
• Three Rivers Health Plans
• United Health Care (Not All Physicans Participate)
• United Health Care, a product of First Health
• U.S. Department of Labor Workers' Compensation
• West Virginia Workers' Compensation

The Neurosurgery Group DOES NOT participate with the following insurance plans:

• Alliance PPO
• Aperature
• Choice Care/ Humana Network
• Coordinet
• Great West
• One Health Plan
• West Virginia Medicaid
• If your insurance plan is NON-participating or NOT listed, see information below.

(Note: This list is last updated October 2004. Insurance contracts require renewal on a yearly basis, so check with your insurance carrier if there is any doubt about our participation.)

If The Neurosurgery Group “participates” with your insurance plan, then we have negotiated an agreement with your insurance carrier, and have agreed to accept a predetermined amount for services rendered.

Under the terms of all insurance plans, the patient is responsible for obtaining their own referral.

EVERY INSURANCE PLAN IS DIFFERENT. YOU MUST READ YOUR PLAN CONTRACT TO DETERMINE YOUR SPECIFIC COVERAGE.

Even if you have insurance coverage, you may still be responsible for some or all of the fees for your care:

1. Most insurance plans require small co-payments for initial consults and office visits. Co-payments are due and payable at the time that services are rendered.
2. Pre-approval of services is required by many carriers. Without pre-approval, you may be responsible for fees.
3. Your insurer may only pay a certain percentage of your charges, in which case you will be responsible for the balance.
4. Your insurer may choose not to approve payment for certain services base upon the determination of “medical necessity." In this case, you can appeal the insurers decision. We can support you in your appeal, but your insurer makes the final determination, regardless if your surgeon documents his opinion on the medical necessity of the procedure.
5. Your insurer may place lifetime or annual limits on some care, such as physical therapy services. Your surgeon CANNOT appeal coverage decisions based upon these limits.
6. Your insurer may consider certain procedures “experimental,” in which case they may choose not to cover services.
7. Your insurer may choose not to cover services of a physicians assistant.
   

AGAIN: EVERY INSURANCE PLAN IS DIFFERENT. YOU MUST READ YOUR PLAN CONTRACT TO DETERMINE YOUR SPECIFIC COVERAGE.

Information for Patients with Nonparticipating Insurance

• If your insurer does not have a contract with The Neurosurgery Group, then services rendered by our physicians are considered “out-of-network.”
• Check your plan contract to see if “out-of-network” services are authorized.
• Typically, “out-of-network” services, if covered, are covered at 50-80% of our usual and customary fees. You will be responsible for any balance not covered by your insurer.
• If your insurance plan does not allow “out-of-network” services, see information below for patients with no insurance.

Information for Patients covered by Workers' Compensation or Auto Insurance

• The Neurosurgery Group DOES participate with many workers' compensation and auto insurance plans.
• We require a determination letter from the compensation or auto carrier that you have a valid claim, and that payment is guaranteed.
• Many compensation and auto claims are contested or disputed – therefore, without a letter of coverage, we require coverage from a standard health insurer (such as Blue Cross/Blue Shield) as a “backup” plan.
• If you do not have a letter of determination yet, and have no standard insurance as a “backup,” then see the information below for patients with no insurance.

Information for Patients with NO Insurance

• We will not turn away patients because of a lack of insurance.
• Just like our insured patients, you will need to sign a financial responsibility form.
• Call our billing office to make arrangements for payment – our staff can arrange a payment plan.
• In cases of demonstrated financial need, fees can be reduced or waived.
• In the case of inpatient care or surgery, keep in mind that separate arrangements will need to be made with the hospital which bills separately for its services.

Payment Options

The Neurosurgery Group of Western Pennsylvania accepts the following forms of payments:

• Cash, Check, or Money Order
• Visa, Mastercard, Discover
• Debit Cards