Know the Cost of Your Services Upfront
For Patients Who Want to Pay Directly for Their Care
At Columbia Orthopaedic Group, we believe in price transparency.
At Columbia Orthopaedic Group, our goal is to make treatment a convenient "one-stop-shop" for our patients. Most of our services can be done on-site, including exams, imaging including x-ray and MRI. Pricing transparency is part of our goal.
If you see a doctor or other healthcare provider that is not covered by your health insurance plan, this is called "out of network," and you will have to pay a larger portion of your medical bill (or all of it) even if you have health insurance.
COG Business Office Team
What is pricing transparency?
Patients can now shop for healthcare the same way they shop for everything else – with price, quality, and convenience. At COG, we believe in providing self-pay patients with pricing transparency, so you know the cost of your services upfront.
We offer bundled payment options for those seeking to pay directly for care apart from an in-network insurance plan. Bundles benefit self-pay patients, self-insured employers, patients with out-of-network insurance coverage, health sharing ministries, and anyone who bears the out-of-pocket expense for our services.
Pricing transparency is a tool for self-pay patients to use when they want to know the costs of the services we provide. We offer bundled payment options through HealthMe for those seeking to pay directly for care apart from an in-network insurance plan. This way, self-pay patients know exactly what they're paying for ahead of time, including exams and treatment plans.
When you are able to avoid surprise bills, you can focus your energy on getting back to pain-free living.
Have questions? Contact our business office at (573) 443-2402 ext 406.
FAQs about Out-of-Network Insurance, Self-Pay and Out-of-Pocket Cost for Insured Patients
Out of Network Insurance Plans
What if my insurance plan tells me COG will be paid an in-network rate?
When an out-of-network plan says it will pay the practice an in-network rate, that means the plan will pay us less than the price we have set for the service. Our rates are fair and transparent, so we are not willing to accept less from an out-of-network plan.
Can I use my Medicare/Medicaid?
Patients who are beneficiaries of government programs are not eligible for participation. If you are a beneficiary of a government program or an in-network patient and inadvertently purchased a self-pay package, HealthMe will provide you with a full refund. Please contact our team at 573) 443-2402 ext 406.
Will you file my insurance even though you are out-of-network?
Yes. We will submit your claim to your insurance plan, but we also ask that you pay for services in full at the time of service. We will refund you any balance after your plan pays or credit it to a future service if you have one. Some plans require us to accept a discount if we receive payment directly from them. In those cases, we will ask the plan to pay you directly.
Self-Pay and Out-of-Pocket Calculations
Can I get an itemized billing statement?
If a bundled package was purchased, we cannot itemize. By definition, a bundle is a set of services offered for one all-inclusive price. We can provide an invoice that lists the services included in the bundled rate.
Do I have to purchase the package from the webpage?
If you are not able to purchase the bundle online with a credit card, we will accept payment at the office prior to your appointment.
Why do I have to pay ahead of time?
While we understand it's hard to plan for unexpected medical issues, our rates are fair and transparent. We strive to provide as much information up-front as possible, so you do not receive large surprise bills after your care.
We require payment in advance because the care we offer is expensive to provide. Our physicians use expensive equipment and supplies to diagnose and treat patients. Our surgery center must purchase expensive implants for most surgeries before the surgery is performed. We incur those expenses before you receive the care, so it's important for us to recover that cost.
We offer Care Credit to patients who need assistance with the pre-payment requirement. We can offer a pre-payment plan allowing you to pre-pay installments toward a surgery date in the future.
Why do I have to pre-pay when I have insurance?
If your insurance plan requires you to contribute to the cost of your care, we will calculate that amount based on your plan's requirements and collect it from you prior to the service being rendered.
We require payment in advance because the care we offer is expensive to provide. Our physicians use expensive equipment and supplies to diagnose and treat patients. Our surgery center must purchase expensive implants for most surgeries before the surgery is performed. We incur those expenses before you receive the care, so it's important for us to recover that cost by collecting the total amount due, not only the portion insurance pays.
Can I set up a payment plan for the pre-pay amount?
We can offer a pre-payment plan allowing you to pre-pay installments toward a surgery date in the future, but we generally do not set up payment plans for patient deductibles to be paid after a service has been rendered.
Factors that may influence this decision on a case-by-case basis including whether the surgery is elective; the patient's payment history with the practice; our up-front cost to render the service; and the portion of the total payment due to the practice or ASC that is the patient's responsibility versus the insurance plan's responsibility.
I shouldn't have to pre-pay because I have claims from other doctors that will meet my deductible before this surgery.
Insurance plans pay claims in the order they are received. We cannot guarantee that other claims will be submitted and processed prior to our claim. We will re-verify your benefits and expected out-of-pocket upon request prior to your payment.
Do you have any assistance programs to cover the medical costs?
I have met my deductible. Why do I still owe money for this surgery?
Your insurance plan requires you to contribute to the cost of your care by paying a deductible and a percentage of the charges up to an annual out-of-pocket maximum. We are collecting the expected out-of-pocket amount based on information received from your plan.
Why can't I pay the day of surgery?
We require payment in advance because the care we offer is expensive to provide. Our physicians use expensive equipment and supplies to diagnose and treat patients. Our surgery center must purchase expensive implants for most surgeries before the surgery is performed. We incur those expenses before you receive the care, so it's important for us to recover that cost. The surgeon and the surgery center block out time in their schedules for your procedure, which makes that time unavailable to other patients. Pre-payment 5 days in advance is required to reserve that time for you. Surgery day is also busy and stressful. Pre-payment reduces the stress of the day and prevents your surgery from being rescheduled if you were to forget your payment.
If my insurance carrier states that I don't have to prepay, why is COG asking for the prepay?
We only ask you to pre-pay the amount that your insurance plan has indicated you will owe based on your deductible, co-pay, and/or co-insurance. We calculate your specific out-of-pocket estimate based on the rates your plan allows for the services and your specific plan benefits. If claims from another provider are processed before ours and that reduces your out-of-pocket responsibility, we will refund any balance due to you in a timely manner.
Will I be refunded if insurance pays and credit is on the account?