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Out-of-Network surgical centers have much lower infection rates than hospitals. The selected Out-of-Network surgery center allows physicians to use top of the line products that maximize patient outcomes as well as produce faster recovery times.
It depends on your insurance plan as AllianceMed does not dictate costs. However, we will work with the provider to see what the patient’s personal finances will allow for them to pay.
AllianceMed checks the benefits of all their patients to ensure they have the correct benefits before surgery is scheduled. By verifying the patients Out-of-Network benefits, AllianceMed can help limit out of pocket costs.
By using a selected Facility or Physician and their Out-of-Network benefits a patient will be allowing the Physician to take them to a state of the art facility and to be able to use the best possible implants, stem cells, and DME, to provide the best possible patient outcomes.
The main reason the doctor chooses a particular facility over any other is because they want to be able to use the best products, in the highest quality setting available for the patients surgery, thus providing a maximum level of care for the patient.
The first bill that hits the insurance company will be the first one applied to the deductible, if the insurance company determines that it is a covered benefit. By utilizing AllianceMed, they can ensure that the DME claim goes out before the professional or facility claims go out, this gives the provider the best chance of absorbing deductibles and making each event that follows a profitable event.
AllianceMed specializes in Out-of-Network claims submission but has the ability to submit claims In-Network when needed. Ideally the provider will continue to use the current billing for in-network claims.
Insurance carriers likes to have providers submit claims electronically because it is a simple process for both parties, yet Out-of-Network policies require that the claim should be submitted as a hard copy. When submitting a hard copy the Facility or Physician is able to submit all supporting documents (Op reports, medical necessity, etc) that will increase the likelihood of the claims getting processed correctly and efficiently.
An overpayment is an attempt by the TPA to recover money that was previously paid out to the medical provider for services rendered. Insurance company obtains recoupment from the provider by withholding future payments from other patients.
They bill the same way hospitals do, and the bills are high because they use the top of the line equipment to ensure the patients speedy recovery.
Prior to any claims being billed through AllianceMed Titan Billing Process, all rates will be agreed upon with AllianceMed Rate Addendum Agreements to ensure that both parties agree that these rates are reasonable for the services provided. AllianceMed has in-house attorneys who review these claims to ensure that everything is above board throughout the entire process.