Insurance

A visit to the Chiari Institute often includes testing, multiple physician consultations and, if warranted, surgery. Our neurosurgeons do not participate with any managed care insurance companies, however, your insurance company may pay out-of-network. When an insurance company pays out of network, you could only be responsible for a portion of the physician’s charge. Often the patient will be responsible for a certain percentage of the total bills and/or required to meet a deductible. This should be discussed with your insurance company prior to your visit.

Even though the physicians are not in-network with your plan, the hospital or testing facility charge might be processed as if they are.  This would need to be confirmed with your individual insurance carriers. We will make our best attempts to schedule your testing with an in-network facility to avoid any out-of-pocket expenses.

Out-of-Network vs. In-Network

Out-of-network

Out of network is when a patient receives services from a non-participating provider. Generally, patients doing so have greater financial responsibility then those receiving services from participating providers. Some patients may not have any benefits for out-of-network services.

Example - Doctor X charges $100 for a procedure. The patient’s out of network benefit is to have the claim paid at 70% of their usual, customary and reasonable (UCR) fee.

UCR Allowance - the fee determined and payable by the claims payor. Each insurance carrier has a different UCR rate for every procedure.

The insurance advises their UCR is $40 for the billed procedure. The insurance company will pay 70% of the $40, which is $28 as long as their deductible has been met. The patient is responsible for $72.

Deductible - An amount the insured person must pay before insurance payments for covered services begin.

Each insurance policy has a different out-of-network benefit.  Please contact your insurance company directly to review your policy.

In-network

In-network is when a patient receives services from a participating provider in a managed care plan. Generally, patients receiving in-network services from a participating provider are responsible only for a co-payment.

Example - Doctor X charges $100 for a procedure. The doctor will accept the insurance payment as payment in full, but the patient could be responsible for a co-payment or co-insurance.

Co-payment - A pre-established payment that must be made by the member under the particular plan option of benefits, e.g., for an office visit, emergency, etc.

Co-insurance -The percentage of the costs of medical services paid by the subscriber.