Out-of-Network Patients

South Bay Plastic Surgeons is out of network with most PPO insurance carriers. That means that we do not have a contract to accept their in-network rates for our services. In-network reimbursement rates cover less than the cost of providing services, and we have decided that the best way to serve our patients is to not participate in these low-paying contracts.

What Are Out-of-Network Benefits?

Many health insurance plans have out of network benefits. These are benefits that pay a percentage of the fair rate for health services (the fair rates for out of network services can be found here: https://www.fairhealthconsumer.org/.

Every individual has a different plan with different benefits and payment responsibilities. According to your plan you may be eligible for out-of-network reimbursement for these fees.

How We Help You Navigate Out-of-Network Benefits

Insurance Verification:

• Our practice offers a complimentary service to verify benefits and to educate you on your out-of-network coverage.
• Once we have a chance to verify your benefits we will review these with you and give you a cost-estimate for any co-pay or deductible you might owe for services to our office.

Claims Submission:

• Our office will handle all pre-authorizations for services rendered by our surgeons. 
• Our practice handles paperwork and submits claims to insurance.

Why Choosing an Out-of-Network Provider Can Be Beneficial

Access to Specialized Care:

• Patients can choose the best provider for their needs, rather than being limited to an insurance network.

More Personalized Care:

• Out-of-network providers often have more flexibility and time to spend with patients, allowing for more thorough consultations and treatment.

Higher Quality Services:

• Many out-of-network providers prioritize patient care over volume, leading to higher quality and more comprehensive services.

Tailored Treatment Plans:

• Customized approaches to patient care that may not be possible within insurance constraints.
• Our surgeons will see you for every post-operative visit and will not delegate this care to assistants.

How To Maximize Your Out-of-Network Benefits

Whether or not you have out-of-network benefits, we want to work with every patient to help them get the care they need. Please speak with our office staff about any questions.

Visit the Centers for Medicare & Medicaid Services website for more information: https://www.cms.gov/newsroom/fact-sheets/no-surprises-understand-your-rights-against-surprise-medical-bills