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Emergency Services

 

Many of our clients provide emergency surgical services to the public as Surgicalists or assistant surgeons. F5 Surgical specializes in facilitating the processing of emergency surgical claims at all levels of the surgical process. As a provider with F5 Surgical you get the most experienced servicers with a deep knowledge of emergency insurance claims processing.

If you are a patient and have questions about your surgical bill for your recent emergency surgery, please don't hesitate to contact us, so that we can assist you in resolving your issue.

The Affordable Care Act of 2010 removes insurance company barriers to emergency services. Health plans cannot require higher copayments, deductibles, out-of-pocket maximums or co-insurance for out-of-network providers or hospitals outside of your plan's network. This means that even though the surgeon or hospital that you go to for an emergency is not in your network, your insurance company must treat it as an In Network situation per federal law.

The act states that non-contracted providers are to be paid at the commercial usual and customary rate to prevent the patient from being penalized in an emergency situation for charges that are above a network provider rate. If your payer places these charges on you for an emergency service, they are in violation of the law and may be subject to significant federal penalties.

If you feel that your payer is under paying your claim resulting in a larger patient responsibility, we recommend a review of the charges at Fairhealthconsumer.org. This is a non-profit organization that provides increased transparency in out-of network charges by zip code. By discussing these facts with your plan administrator, most patients find success in resolving their issue.

 

 

 

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