Once they have done that, someone from the business office will call you to talk about payment arrangements for any part of the cost that is designated a “patient responsibility.” The staff will work with you on a payment program. Payment is expected before surgery.
If you have any questions about the financial issues related to your surgery, please call our billing office at (401) 681-2708.
Frequently Asked Questions:
What is a deductible?
A deductible is a set amount for which you are responsible in the course of a year according to your contract with the insurance company. For example, if you have a $500 deductible, you must pay $500 out of pocket on any services the deductible applies to before the insurance will make a payment. A deductible amount generally applies for one year. Once the year is over, the deductible must be met again. The deductible amount is determined by your insurance plan.
What is coinsurance?
Coinsurance is a percentage of each charge for which you are responsible. This amount is determined by your insurance policy and is non-negotiable. If you have a 20 percent coinsurance, for example, you are responsible for 20 percent of each specific negotiated rate by charge code. Therefore, if the practice has a negotiated rate of $1,000 for a surgical charge code, you are responsible for $200. Some plans do not have a coinsurance amount. You can call customer service on the back of your insurance card to find out if you have coinsurance.
What is a negotiated rate?
If Affinity Orthopedics & Sports Medicine (AOSM) is participating in your insurance plan, we have agreed to a negotiated rate with your insurance company for the covered services we provide to you. The negotiated rate can be less than the amount we charge for the services. Getting care through a physician who participates in your insurance plan makes the negotiated rate available to you. For example, AOSM may charge $1,250 for a service but has agreed to accept $1,000 from patients covered under your insurance plan. The $1,000 negotiated rate (or allowable amount) will be applied to your deductible and/or coinsurance, if applicable.
What are covered services?
These are services your insurance plan includes in your coverage. For example, some insurance plans do not pay for braces. Therefore, braces would not be a covered service, and you would be responsible for paying for them in full.
You had a procedure with a $1,000 negotiated rate; you have not met your $500 deductible and have a coinsurance of 20 percent. The deductibles and coinsurance amounts are determined by your insurance.
|AOSM standard charge:||$1,250|
|Negotiated rate(allowable amount)
|Adjustment subtracted by AOSM:||- $250
|Balance Due to AOSM
|Amount Paid by Insurance Company
|Balance due by you (deductible and co-insurance)
|Amount applied to your deductible
|Amount applied to your co-insurance
*The unpaid $500 deductible and $100 which is 20 percent of the $500 balance after deductible)