Out-of-Network Billing
We are glad you asked about how out-of-network billing works. It can be a bit confusing and not everyone has seen an out-of-network doctor before so we’re always happy to have the opportunity to discuss how things work and make sure we set expectations appropriately. Dr. Pace has chosen not to contract with any insurance carriers, and therefore we do not have a contract that obliges them to pay a given amount, pay in a specific timeframe, or respond in line with the standard practices in the industry. As we’re all too familiar with, insurance processing can be unpredictable, but we do want you to be aware that the process can take longer with out-of-network billing.
As a courtesy to our patients, we do have a specialized billing department who is quite experienced with this process. If you have any questions, they are available to provide updates and assistance. As much as we love our team, please do keep in mind that we are at the mercy of the insurance companies, so ultimately they set the timeline and control the process. If we are reimbursed by your insurance company, we want you to be aware that bills from other providers or facilities remain separate from our surgical fees.
Dr. Pace is an out-of-network provider with all insurance carriers. However, we may still bill your insurance on your behalf through the No Surprises Act (NSA) protections. Under this law, you cannot be billed beyond your in-network cost sharing amount, and it is then applied towards your in-network out-of-pocket maximum. In many cases, once your in-network limits are met, you may have little or no additional responsibility. Patients with insurance plans such as Medicare, Medicaid, and Tricare are not eligible to proceed with insurance through our practice. Please note that insurance can only be billed if your plan offers out-of-network benefits.