As the CEO of SpecialtyCare (and as a surgeon), I feel it is imperative that I respond to a recent article published by NPR that shares a patient’s unfortunate financial experience with an Intraoperative Neuromonitoring (IONM) company that provided services during an important spine procedure on a young woman. READ THE ARTICLE HERE.
I want to assure all of our employees, surgeons, and patients that SpecialtyCare’s billing process is in complete contrast to that mentioned in the article and I want to share with you how we are different.
Unfortunately, some IONM companies charge rates that are 5 to 10 times higher than the usual and customary standard established in our industry and then attempt to collect the portion of this bill that is beyond what the insurance carrier will pay for from the patient. This is called “balance billing.” Balance billing is when a person or company, like the company mentioned in this article, attempts to bill the patient in excess of their copay and deductible, and again, outside of what the patient’s insurance plan will cover.
Here is the SpecialtyCare difference:
- Our charges are in-line with industry standards.
- We accept the insurance allowed amount for ALL cases/payers. This means we accept the final adjudicated amount as payment in full and only bill patients for their deductibles and co-pays as determined by the payer. We DO NOT balance bill patients.
- We do not have any ownership by practicing or referring surgeons for the following reason: When physicians, and in this case surgeons, refer patients for a procedure to a group in which they have financial ownership there is the possibility of a conflict of interest between what is best clinically for the patient and what is best financially for the surgeon. These practices can potentially violate what is called the Stark Laws or Anti-Kickback statutes that the federal government has put in place to protect patients from this conflict.
- Our patient advocacy team raises awareness with patients regarding the use of IONM and educates patients on what to expect from the billing process and we provide patient brochures and IONM content to surgeon offices for early education.
- We advocate on behalf of our patients. When we are out of network with the insurance provider, we appeal our claims and advocate for in-network treatment by payers related to patient co-pays and deductibles. We do this with a high success rate.
SpecialtyCare’s IONM practice supports over 120,000 patients annually in over 900 partnering hospitals and surgery centers in the most ethical and compliant way. I am very proud to be associated with a company whose high standards span from our medical delivery to our billing practice.
Sam Weinstein, MD, MBA