The Surgery Scheduling Department will contact your insurance company to verify your coverage and to obtain any authorization / pre-certification for your surgeon’s services. If you have not given our office complete insurance information; please contact the Surgery Scheduling department immediately.
We strongly recommend that you contact your insurance as well as to ensure a better understanding of your benefits as they pertain to your surgery. Authorization for surgery by your insurance company does not guarantee payment of benefits.
Our office will submit a bill to your insurance company. If we do not have a contract through a PPO (Preferred Provider Organization) and do not receive payment within 30 days you will receive a billing statement which is due in full upon receipt. If your insurance is a PPO plan and there is a patient liability balance, you will receive a statement for any remaining balance due in full upon receipt.
You will receive a statement an Explanation of Benefits (EOB) from your insurance company from four separate providers of service. Your surgeon, the facility, the anesthesiologists and the assistant surgeon if used.
If have questions about your surgeon’s fee please email us at firstname.lastname@example.org or you may call Maryam Hashemieh at 650-851-4900.
Please note that even though the doctor orders Durable Medical Equipment (DME) for your surgery, it is not mandatory that you use this equipment. We are not responsible if your insurance does not cover the cost of Durable Medical Equipment. It is your choice to use DME and call your insurance company for benefit coverage.
Preferred Provider Organization (PPO)
If your insurance requires you to see a contracted physician/surgeon on its list, please check to make sure our surgeon is a member of your plan. This is the patient’s responsibility. Not all physicians in our office participate with all of the same insurance plans.
The Surgery Financial counselor can give you an estimate of the surgeon’s fee, however for questions regarding any out patient facility charges you must call 650-367-5549 for Sequoia Hospital and for SOAR Surgery Center, 650-539-6000. Your billing information is provided to all facility/providers involved in your case. However, all fees incurred for services outside of SOAR, such as the assistant surgeon, anesthesiologist, hospital, etc, is not our responsibility. We can not guarantee all other providers of services are contracted with your insurance.
Usual, Reasonable and Customary
Our fees are set according to our geographical location, the high level of expertise and quality of care our physicians provide. Some insurance companies that we are not contracted with will indicate that our fees are above their usual and customary rate. You will still be responsible for the full amount of the charge. The only time we allow for an adjustment is if your insurance is a PPO with which our organization has a contract.