Private Insurance

Office Visits
If our physicians are participating providers for your insurance company, we will file office visit charges. You are required to pay your co-pay when you check in for your appointment.

If Southeastern Neurosurgical and Spine Institute is not contracted by your insurance plan, you will be expected to pay for your first office visit and all subsequent visits at the time of service. The fees range from $30 to $350 for the first visit and $60 to $175 for follow-up visits. You will be given a charge ticket which may be attached to your insurance form so you may file for reimbursement.

Hospital Services
As a service to our patients, we will file all of our physicians’ charges for your surgery. Our Patient Account Representatives will review with you your estimated surgical charges. She will calculate what we expect your insurance company to pay and what your financial obligation to our office will be. Prior to your surgery, you are required to pay at least one half of the charges not covered by your insurer. The balance will be due within 30 days of your discharge from the hospital.

We will send you a monthly statement that will indicate if your insurance company has paid. If you receive two statements and your insurance company has not paid, it is your responsibility to contact your insurance company to see if there is a problem. If your insurance company has still not paid after three months, it then becomes your responsibility to pay the bill and wait for reimbursement from your insurer.

Usual and customary is the term that insurance companies use to indicate what they allow for procedures. Different insurance companies have completely different usual and customary allowances for procedures. This office does not base its fees on any usual and customary schedule.

NOTE: If you are seeing us due to an injury you had at work or due to an auto accident, please call one of our Patient Account Representatives as your appointment must be pre-authorized. If your appointment is not pre-approved, your appointment may be rescheduled.

Medicare

Our physicians are Medicare Participating Providers which means that Medicare will tell us the amount to charge for our services. Of the amount Medicare allows us to charge, Medicare will pay 80% and you (or your supplemental insurance) will pay 20%. In addition, Medicare has a $100 yearly deductible that you will need to pay before Medicare pays. Your co-pay (which is 20% of Medicare’s allowed amount) is due at the time of your appointment unless you have a supplemental insurance policy.

If you have a supplemental insurance policy, we will file with that secondary insurer after we receive a response from Medicare. You wile receive a ill from us the month following Medicare’s response. We allow 60 days from the date Medicare responds for your supplemental policy to pay. After 60 days, the balance becomes your responsibly.

Please bring your Medicare card with you so that we can copy it for our records. If your spouse is employed and has insurance covering you, or if you have other insurance that is primary over Medicare, please bring those insurance cards with you also.

Medicaid

If your are covered by South Carolina Medicaid, this office will file for you and will accept the Medicaid payment for any services that are covered. If a service is denied by Medicaid as non-covered, you will be responsible for payment for that service. One example of this would be if you have no remaining visits available for the month. Please bring your Medicaid card with you for each visit and let the front desk person make a copy for our records.

If you have other insurance coverage in addition to Medicaid, it is very important that you notify us. We will still file the insurance for you and accept the insurance payment or the Medicaid allowance as payment in full.

For Pending Medicaid Sponsorship:
If you have applied for Medicaid coverage, but do not yet have approval, please notify our office as soon as you get the Medicaid number. Once you receive the card, please ring it to our office and let us make a copy so we can file your claims for you. There is a time limit for filing Medicaid claims’ if we are late because you did not notify us of your coverage, you will be responsible for paying for the services.

If you have any questions, please call one of our Patient Account Representatives at 864-454-4600.