Out of Network
We work very hard to maintain contracts with all insurance companies and are "in network" with a majority of insurance carriers, including Medicare. There are a few insurance companies who restrict their networks to physicians and/or facilities who practice within a regional medical group. There are also plans, such as HMOs, offered by insurance carriers that we contract with, for which we are out of network, even though we are in network for other plans they offer.
The Skin Cancer Center understands that insurance networks are shrinking. As such, wait times for in-network physicians can be long and many networks lack sufficient resources including properly trained physicians or equipped surgical facilities. It is imperative to care for skin cancer quickly as the longer it goes untreated the larger the cancer grows.
Should you elect to utilize out-of-network benefits to see Dr. Piasecki for the treatment of skin cancer, our trained staff can assist you expeditiously in the process. Out-of-network patients should have a consultation with Dr. Piasecki prior to making any care decisions.
In some cases, our insurance specialists can work with your insurance company to pay at an in-network benefit level. Because Dr. Piasecki is the only doctor in the world with his credentials, there are many insurance networks that do not have a physician or facility that is trained/equipped for the reconstruction required. If your insurance network does not have a physician who is Board certified in facial reconstructive surgery, for example, you are not near a facility that has the necessary equipment for a complex facial reconstructive case, you may apply for a “benefit level exception” and if granted, your insurance company will pay for treatment at an in-network rate. In these cases, if allowed by your insurance company, we will file the necessary paperwork with your insurance company on your behalf. Before trying to get authorization at an in-network rate, insurance companies require that a consult be billed whereby the patient is responsible for any out of network co-pays, deductibles, etc. as dictated by your plan.
If you decide to have treatment at an out-of-network rate, and we do not apply for in-network coverage, we are not obligated to bill your insurance. In these cases, we have decided that the initial consult is free. During the consultation, Dr. Piasecki will discuss all treatment options and provide you with a quote for the treatment you decide upon together.
Out-of-network patients are responsible for payment of the entire procedure cost up front. We can help you secure financing for all of your healthcare costs, including travel, through outside financers. Post surgery you may file a claim with your insurance company. We will provide you with all paperwork required including diagnosis and treatment codes. We uphold the highest level of standards and will not over or under code procedures for insurance purposes. Please understand that due to the nature of skin cancer, it is not always possible to assign procedure codes in advance. Therefore we must wait until the cancer is removed and reconstruction is complete. Dr. Piasecki will provide an educated presumption of your surgical requirements so that we may help you in estimating how much your insurance company is likely to reimburse you for the procedure. This estimate is based on fee schedules for plans in our network; we do not have access to plans with which we are not affiliated. Reimbursement by your insurance company is based on their fee schedule and your individual plan coverage.
Our fee covers all subsequent care for a year following surgery. This includes staged reconstructions, follow-up care and any revisions Dr. Piasecki would like to make for cosmetic purposes.