Know the Cost of Your Services Upfront

Know the Cost of Your Services Upfront

Pricing

For Patients Who Want to Pay Directly for Their Care

At Columbia Orthopaedic Group, we are committed to providing pricing transparency to ensure our patients can make informed decisions about their care.

Our goal is to create a seamless and comprehensive care journey for our patients. Most of the services you need, such as exams, imaging (including X-rays and MRIs), and consultations, are available on-site. Pricing transparency is an integral part of this commitment, ensuring there are no surprises when it comes to costs.

If you choose to see a doctor or healthcare provider who is out-of-network with your health insurance plan, you may be responsible for a larger portion—or even the full amount—of the medical bill. We encourage you to contact us or your insurance provider to better understand your financial responsibility.

For more information about self-pay options, out-of-network billing, or detailed cost estimates, please reach out to our team. We're here to help make your care accessible and straightforward.

What is pricing transparency?
Pricing transparency refers to the clear, upfront communication of the costs of medical services to patients before they receive care. This includes information about the fees for consultations, procedures, tests, and treatments, as well as any potential additional costs like facility fees or follow-up visits. It often extends to explaining how insurance, copayments, and deductibles affect the final out-of-pocket expenses for the patient.

Have questions? Contact our Financial Services at 573-876-1002.

FAQ


FAQs about Out-of-Network Insurance, Self-Pay and Out-of-Pocket Cost for Insured Patients


Out-of-Network (OON) Insurance FAQs

What does it mean if my provider is out-of-network?
Out-of-network providers are not contracted with your insurance company. This often means you may have to pay higher costs, as your insurance typically covers a smaller percentage of the bill.

Will my insurance cover out-of-network services?
It depends on your insurance plan. Some plans partially cover out-of-network services, while others (like HMOs) may not cover them at all. Check your policy for details about OON benefits.

How can I find out if my provider is in-network or out-of-network?
You can check your insurance company's provider directory online or contact the provider directly to confirm their network status.

What is balance billing, and will I be charged for it?
Balance billing occurs when an out-of-network provider bills you for the difference between their charge and the amount your insurance covers. However, this is restricted in some cases by the No Surprises Act in the U.S.


Self-Pay FAQs

What does self-pay mean?
Self-pay means you are responsible for covering the full cost of your medical services out-of-pocket, without using insurance.

Can I get a discount if I self-pay?
Many providers offer discounts for self-pay patients since they avoid administrative costs associated with insurance claims. Ask your provider about any available self-pay discounts or payment plans.

Is self-pay cheaper than using insurance?
It can be in certain cases, especially for uninsured patients or those with high deductibles. Always ask for a cost estimate to compare.


Out-of-Pocket (OOP) Costs FAQs for Insured Patients

What are out-of-pocket costs?
These are expenses that you must pay directly for medical services, including deductibles, copayments, and coinsurance.

What is a deductible?
A deductible is the amount you must pay for covered healthcare services before your insurance starts paying. For example, if your deductible is $1,500, you must pay this amount out-of-pocket before insurance covers additional costs.

How do copayments and coinsurance work?

  • Copayment (copay): A fixed fee (e.g., $25) you pay for specific services like doctor visits or prescriptions.
  • Coinsurance: A percentage of the cost (e.g., 20%) you pay after meeting your deductible.

What is the out-of-pocket maximum?
This is the maximum amount you'll pay in a year for covered services. Once you hit this limit, your insurance covers 100% of costs for the remainder of the year.

Can I ask for an estimate of my out-of-pocket costs?
Yes. Providers and insurance companies can usually provide an estimate based on your insurance plan and the specific service.


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?
No.

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?
Yes.