Financial Policy

Our philosophy is inspired by our own experiences in the healthcare system, as patients.  As a result, we built our practice focusing on the patient experience, and created resources that help our patients better understand the various components of their surgical endeavor. 

With years of providing concierge service to our patients, we’ve discovered that most people benefit from help figuring out the complex and often vague world of insurance coverage.  An important part of this is access to knowledge and clear information about the complexities of their coverage.  Finding clarity in what services you can consume, and which ones will cost you more (because of limitations imposed by your particular insurance provider) is something that is challenging.

So we created a plain language, simple to understand guide specifically tailored for your experience with us, at evo.  Although it’s difficult to provide a completely reliable predictor of the financial outcomes of your procedure, we have made every effort to develop a solution that can grow and evolve.  

Our goal is to provide a better understanding of your insurance coverage, and bring transparency to the financial process associated with your experience at evo.  We invite you to keep engaged, and provide feedback on how we can add to this guide to help provide you with the most truly excellent experience.  

We hope this guide helps demystify the insurance reimbursement process and empowers you to get the most out of your plan.  We have always been, and will continue to be patient advocates, and if there is anything we can do to help you with your claim and understanding your policy, please do not hesitate to ask.

We’re privileged to be chosen by you for the correction of your foot problems and are looking forward to providing an exemplary experience.

 

Consultation Fee

If you are a self pay patient, and not using insurance, the consultation fee will be applied toward your surgery balance. It does not expire and will stay on file until you are ready to schedule. 

Deposits

We require a $100 deposit to secure an appointment for a consultation.  This will be applied to your balance.  Deposits are non-refundable.

We require a $1500 non-refundable deposit to secure an appointment for surgery.  This will be applied to your balance for surgery.  Surgery deposits are non-refundable.

Rescheduling Policy

We understand that rare situations may arise that could cause you to postpone your surgery. Please understand that such situations cause our practice to incur certain non-refundable costs and affect the surgeon’s time, the facility, and the operating room staff. 

If you contact us to reschedule your surgery 2 weeks before the scheduled date, we will apply your deposit to your new surgery day.  If however the surgery is scheduled less than 14 days before the scheduled date, we will require another deposit to schedule a new date.  We allow one reschedule within 1 year of the original scheduled date.  

Payment of your balance for the scheduled surgery is due 2 weeks prior to your scheduled date.  If your payment is not received in time, your surgery may be canceled at our discretion.

Cancellation Policy

If you need to cancel your surgery for any reason within 48 hours of your scheduled date, all fees are non-refundable.  If you need to cancel your surgery for any reason within 2-14 days of your scheduled date, a 50% non-refundable cancellation fee will be charged. 

Payment Options

We accept a variety of payment forms, including credit cards or Care Credit.

It is important that you understand, regardless of your surgical outcome the fees are non-refundable. Further, if you complications, or require revisions you may incur additional costs.

Surgery Quote and Potential Costs

We will provide a detailed surgery quote with the expected costs of your procedure.  An accompanied benefits analysis will be based on the most recent benefits check our team performed.  Although we will have contacted your insurance provider and compiled your benefits, the quote may have variances based on your fee schedule.  This could be due to your insurer or the representative our team speaks with providing inaccurate information, which unfortunately happens often.

Insurance Billing

As part of our commitment to our patients, and the philosophy of excellence that is at the core of evo, we will bill your insurance provider and follow up on claims as a courtesy.  It is important to note that we do not contract, and are out-of-network with all insurance providers.  In a traditional out-of-network model, the patient pays for the service and is provided a superbill, which they submit to their insurance provider for reimbursement.

Please keep in mind that we will work hard to get your claim paid by your insurer, however most insurance providers consistently seek to pay less, and transfer the cost burden to the patient.  We will advocate best we can for you, but cannot guarantee the outcome of the processing of your claim.  Your participation will help get the most value from your insurance provider.

Understanding In-network vs. Out-of-network

Insurance companies sell their products in different versions or offerings.  Usually plans offer in-network and out-of-network coverage.  Let’s first understand what in-network means.  

A typical insurance plan maintains a network of doctors who are contracted with the insurance provider.   When doctors apply to become contracted providers for insurance networks (contracted doctors get listed in the network directory), they agree to perform procedures for contracted, in-network rates.   

Those rates are listed as examples in your example claim (provided separately with this guide).  These rates are generally less than out-of-network doctors are reimbursed for the same service.  The reason this matters is because the difference in reimbursement allows for out-of-network doctors to see less patients, and spend more time with their current ones.  We think this is important.

Our practice philosophy is based on the highest quality of service available in foot surgery today.  To provide this, we do not contract, and are out-of-network with all insurance providers.  Although your insurance company will place restrictions to make it difficult for you to see and receive treatment by out-of-network doctors, our goal is to make your experience as seamless as possible.

 

Fee Schedule

The fee schedule describes what the insurance company considers is a pre-determined set of allowable amounts for the procedures in question.  Your insurance company should provide you with a fee schedule as it will give you an overview of how much you can expect your doctor to be paid, and your share of the costs.

It is important to note, that we are not given access to fee schedules, and most insurance companies will not be forthright about their fees schedules with doctor’s offices.  In order to have a clear picture of your financial responsibility before your procedure is performed, we encourage you demand a clear fee schedule from your insurance provider.  We can help provide with the specific procedure codes for the surgical plan you and your surgeon have determined is necessary.

 

Procedure and Diagnostic Codes

Procedures are referred to by codes which are called CPT (Current Procedural Terminology) codes.  CPT codes are used to simplify the billing process for doctors and insurance companies.  Used along side of CPT codes are ICD codes (diagnosis codes).  These codes are used to simplify the diagnosis that supports the CPT code being used.

When you read your explanation of benefits the procedures and diagnosis related to them are sometimes listed with CPT and ICD codes.

 

Explanation of Benefits

An EOB (Explanation of Benefits) is a detail of how the insurance claim submitted by your doctor is processed by your insurance company.  Sometimes there is a check that is attached to the EOB.  This is because some insurance companies will pay out-of-network doctor claims by sending the check to the patient.

This check will be in your name, however this is not a payment to you.  If you receive a check with your EOB, the full amount of the check and a copy of the the EOB should be forwarded to:

Evo Advanced Foot Surgery
PO Box 1360
Studio City, CA 91614

You will receive a bill for this amount if the check is not forwarded to our office.

If you change your insurance plan, and we are not aware of the plan change then you will be billed directly for medical charges.  Please notify our team promptly by emailing support@evofoot.com with your new insurance information.

 

Out of Pocket Fees

Most insurance policies will have some percentage that will be the patient responsibility. This is commonly referred to as coinsurance or “out of pocket fees”.  Another term used for your out of pocket fees is “co-insurance”.

These amounts vary from insurance provider to provider.  If your doctor is in-network, we are required by law to collect this amount from you.  If your doctor is out-of-network, we are NOT required by contract to collect the amount from you and are able to use our discretion.

For example, on an “80/20 plan” your insurance company will pay 80% of the allowed amount of the billed charges.

It’s important to note that this is AFTER the deductible has been met in full.   

 

Deductible

The deductible is a pre-set amount or flat fee that the insurance company has determined for your policy when you purchased your plan.  This is the amount the you are required to pay for covered health care services before the health insurance plan begins to pay.  After you've paid your deductible, you only pay a copay, coinsurance or both (depending on the plan you've chosen) for future services.  Deductibles reset every year when your insurance renews.  All patients are required to pay their deductibles.

For example if your plan has a $2000.00 deductible your insurance will not pay any of your covered services until you've met the $2000.00 deductible.

 

Allowed Amounts

Allowed amounts are how much the insurance company has determined they will “allow” for a certain procedure.  If we’re using the 80/20 plan example, once the 80% of the allowed amount of the billed charges is paid, you will be responsible for the remaining 20% of the allowed amounts.

 

Implant and Hardware Fees

At evo, we have always been committed to using the best technologies for our patients. Surgical implants is one such technology. Our office will break down all of the fees for implants required for your procedure.  Some insurance policies have benefits for these implants.  As a courtesy, we will bill your insurance company, however if the payment received by insurance does not cover the price of the implant then you will receive a bill for the difference.  For example, if an implant costs $1,500 and your insurance pays $1,300 then you will receive a bill for the remaining $200.

 

Surgery Quote and Potential Costs

We will provide a quote  with the expected costs of your procedure.  This will be accompanied with a benefits analysis, based on the most recent benefits check our team performed.  Although we have contacted your insurance provider and compiled your benefits, the quote may have variances based on your fee schedule.  This could be due to your insurer or the representative our team speaks with providing inaccurate information, which unfortunately happens often.

 

Unexpected/Extra Costs

We try our best to bring clarity and transparency to the process of billing and the financial component of your procedure experience.  There will be times however that our forecast of your potential out of pocket costs will be incorrect.  We are sorry for our inability to predict these instances.  The scenarios that would create such a situation could include, but are not limited to:

  • Your surgeon determines in surgery that extra procedures were required to achieve your goal.

  • Your surgeon determines you need further treatment or tests to achieve the goal we expect.

  • Your insurance provider did not provide our team accurate information when your benefits were checked. We promise you to make our best effort to collect accurate information from insurance providers. We have however experienced a few instances in the past where the coverage provided is different than what the insurance company provided us when we checked your benefits.

Please note that you are responsible for understanding the coverage your insurance company provides with the plan you have purchased, and how this coverage may impact your financial responsibility when having a procedure performed by our practice.

  • We experience an unexpected complication that results in the need to perform more procedures, tests, consultations with other providers, travel for treatment, and medications.

Patient Financial Responsibility Acknowledgement

It is important that you understand, that regardless of what type of insurance you have, it is the patient’s responsibility to pay all fees incurred not covered by insurance.

By accepting our financial policy, you agree to pay any and all balances not covered by your insurance company including services provided to you that are denied or uncovered benefits on your particular plan.  You also agree to pay all copays, deductibles, coinsurances at the time services are rendered.

In the event that an insurance check is sent directly to you, you agree to endorse the insurance check and forward the check to our office so that those funds can be applied to your account.

We accept assignment on most insurance benefit plans. In the event you insurance company does not pay the assigned benefit within 90 days, the balance will then be your responsibility.

Please note that some, and perhaps all of the services may be considered non-covered, or reasonable and necessary services under your plan, in that event, you will be held responsible for the fees.  We will advise you of any non-covered services prior to treatment.

You understand that in no way are we able to guarantee that all services will be covered benefits by your particular plan, and hence any benefits that are later found to be uncovered will be your responsibility.  Thank you for understanding our financial policy.

If at any time you have questions about treatment, fees or services, please feel free to discuss it with us promptly and openly.  Your concierge will be happy to provide you with detailed explanations to scenarios that your health insurance company may not have informed you about.

In order to continue providing the excellent medical care you deserve, we cannot make exceptions to this financial policy.