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Costs and Insurance Coverage

We understand that insurance and cost coverage is a concern that is often on the backs of our patients’ minds. We also know that this topic can be a confusing issue, leading to a misunderstanding of how insurance really works and how it plays a part in the cost of your medical care. For these reasons, we have dedicated this page to further explaining how our practice goes about handling our coverage and cost policies. Keep in mind that if you still have any questions or concerns, please do not hesitate to call our office (212-988-1444).

PLEASE NOTE: The Seckin Endometriosis Center is dedicated toward surgical treatment. For these reasons, the following information applies strictly to surgeon charges. This does not include billing for the hospital, anesthesia and other providers involved in your care. Also, travel and lodging is not a part of our quota but should be taken into account by patients traveling from out of state.

The Debate

There has been great debate into where such a specialized form of treatment as excisions surgery, takes place in the discussion of insurance. For a comprehensive look into this issue, feel free to read through the following article.

How do we handle insurance?

The Seckin Endometriosis Center (SEC) is an out of network provider with all insurance companies. This means we bill patient insurance carriers at no cost and help with customary support, but our services will process as an out of network practice. Thus we do accept insurance, but we ourselves simply balance and bill the patient. By having our practice insurance friendly, patients are able to receive the treatment that they need in order to remove the disease, while limiting the cost for their surgery.

What does it mean to be an out of network provider?

An out of network provider is a fairly common practice in such specialized fields as endometriosis deep-excision surgery. Out of network means that while we accept most insurances, we are not contracted to any singular insurance plan, but rather operate outside of insurance companies’ preferred provider networks. To repeat, this does not mean we do not take insurance, but rather we just balance and bill the patient, while working with accepting companies to lower patient costs.

What if I do not have out of network coverage?

Patients without out of network coverage, which includes TriCare, are considered self-pay. But keep in mind, if you do not have any insurance coverage or cannot afford to pay for your treatment, there are a number of ways to obtain financing or medical loans to cover the costs.

Why do we choose to remain an out of network provider?

While at first glance insurance companies can appear to lower costs, this can often come at the expense of provider decision-making and impact the quality of care you receive. To avoid this limitation, we choose to remain an out of network provider, where we can maintain autonomy and thus improve patient care so that you receive the treatment that you both need and deserve. Additionally, by working with you to answering all questions while still accepting insurance, we are able to limit costs to the best of our abilities. The decision you make in your treatment should be between patient and provider, with no third party involvement, especially one that focuses strictly on the financial aspect of your care. While we acknowledge that this is, of course, a key component to your decision making, this should not be the driving factor. Your health is your priority and our goal is to make sure that patients receive the best treatment based on their individual case, in order to ensure they have the highest chance of symptom relief and a healthy recovery.

What is the advantage of an out of network provider versus in network provider?

The difference between in network and out of network providers differ in whether or not you are seeking care outside of your insurance company’s preferred provider network. While an in network provider will be covered by insurance, they can be restricted in providing the proper fine-tuned and expert care that we provide here at SEC. By remaining an out of network practice, we ensure that our patients receive optimal care catered to their individual case. Because we acknowledge that the cost of surgery can play a role in your decision making, we accept insurance and work with our patients to find the best ways that they can limit the cost of their care through the best of our abilities.

What do you need to provide for an insurance check?

The first step we take in limiting the cost of your surgery is checking to see if your insurance provides out of network coverage. We perform this evaluation at no fee, but simply request our patients to send their insurance information within their records package. Patients must make a clear copy, front and back, of their insurance card prior to arrival. Along with this, please send your name, date of birth and social security number of both you and the card holder, making sure to specify who is the patient and who is the card holder, or if they are one and the same. This information will enable us to determine your coverage levels and best find the way to lower your costs. Please feel free to call and discuss our care personally with your insurance company, before sending us any information.

How will we at SEC work with your insurance?

After your insurance information is sent and received by our office, our front desk administrative team will work to check your eligibility and benefits. We will discuss what is covered by your provided insurance and the resulting out of pocket costs upon booking your appointment. At this time we will also provide pre-certification for your surgery if needed. Payment for the cost of your initial expenses will be due at the time of your pre-op. Throughout this process, we aim to lower patient costs and expenses at all times by working individually with patients and their provided insurance networks. Laparoscopic deep-excision surgery is the gold standard of care that endometriosis patient both need and deserve, and we work with our patients to make this a reality.

How much does our treatment cost?

Our fees for treatment vary greatly depending on what you receive: a consultation, an examination with presumptive diagnosis, or most commonly all of the above along with laparoscopic surgery for complete removal of all Endometriosis. Your insurance and whether or not they accept out of network providers also plays a key role in determining the final cost of your surgery. Thus, fees for surgery cannot be determined until the doctor actually sees the extent of Endometriosis and can assess what is involved with its complete removal.

What are accepted forms of payment?

We accept all forms of payment, including Visa, Mastercard, Discover card and personal checks.

How do we aid patients in understanding and lowering the cost of their surgery?

Of course, we are happy to help patients gain an understanding of the charges and payments that may become necessary in order to have the best proper care. No one deserves surprises upon receiving a bill for their surgery, especially those suffering from endometriosis. For this reason, we not only aim to answer any questions patients may have, but we also do our best in processing up front the cost of surgery, providing a rough estimation. We work to lower the cost of our patient surgeries on a case by case basis by providing any assistance required to both gain maximum benefits from health coverage and ensure your entire experience goes as smoothly as possible. For example, for patients with large deductibles and out of pocket costs, we sometimes recommend going self-pay in order to gain self-pay discounts.

Conclusion

While SEC is not a member of any insurance network, this does not mean that all or part of your surgery would not be covered. Once you have a diagnosis, you should discuss your condition with your insurance carrier to determine how much of your treatment plan will be covered under your policy, especially if you need pre-certification before surgery or have a deductible that needs to be met. Our staff will assist you in dealing with your insurance company and with the paperwork necessary to file a claim. Please speak to our office about your situation and we will kindly put you in touch with an appropriate lender.

Our office is located on 5th Ave and 68th NY, NY.
You may call us at 212-988-1444 or have your case reviewed by clicking here.

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