How does “out of network” coverage work with commercial insurance plans (non-Medicare)?
As of August 1, 2021 Brookside Gynecology will provide care as an “out of network” provider- ,meaning we will not have contracts with any insurance plans. Many insurance plans have “out of network” benefits in addition to “in network” benefits. Generally, these benefits cover a portion of the fee charged by an “out of network” provider, but sometimes can be very similar to “in network” coverage. Typically, the amount covered is termed “usual and customary” and reflects the value your individual insurance places on the service. These values can differ greatly among plans. If you have a secondary insurance policy this may also provide additional coverage. Brookside will continue to submit claims to your primary and/or secondary insurance and assist in obtaining coverage as allowed by your plan.
Brookside has found that many insurance plans “in network” coverage may ultimately be similar to “out of network” due to required deductibles, co-pays and co- insurance that must be met whether “in” or “out”. This is especially true when you come to your physician for a problem or health issue. Additionally, Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) may be used for coverage at Brookside.
Brookside will continue to order laboratory, radiologic and surgical services for our patients which should be covered as “in network” as long as the lab, radiology office or hospital is contracted with your insurance. The in-office lab at Brookside is a Labcorp office. This lab is contracted with most insurances, and is here for your convenience. If you choose, or your insurance requires, we can arrange for your blood or specimens to be sent or drawn at your preferred lab. Please let us know at the time of your visit so we may accommodate your request.
We will continue to offer in-office ultrasound services. As always, you are welcome to choose the radiology office that works best for you. The ultrasound will be covered with your “out of network” benefits and importantly WILL NOT include a facility fee that many hospital and free-standing radiology offices charge. Often this additional fee will be charged to your insurer and passed along to you. Again, we recommend you check with your selected radiology office and individual insurance policy to better understand these charges.
Brookside will do everything we can to make this transition to “out of network” provider as simple as possible. We invite you to reach out with any additional questions: (203) 869-7080.