AMC will bill you for our professional anesthesia services; this bill is separate from the facility or surgeon charges. As a courtesy, we will bill your insurance carrier; however you will be responsible for any unpaid balance.
We coordinate with many insurance plans, and will also bill these carriers as well as collect directly from them for covered services. You will be billed and will be held responsible for any co-payments or deductibles required by your policy.
AMC currently participates with:
BCBS of MI
Blue Care Network
Grand Valley Health Plan
Michigan Workers Compensation
Physician’s Care Plan
If you have any questions regarding your bill, either Pre or Post operatively, please contact us (616) 364-4200.
AMC provides anesthesia as either a Physician Personally Performed service or with the Anesthesia Care Team approach.
- The Anesthesia Care Team—involves both an Anesthesiologist in combination with either a CRNA or an Anesthesiologist Assistant. Most insurance carriers require that we submit a claim for both providers, while a minority of carriers requires that we submit a claim only for the Anesthesiologist. If a claim is submitted for both providers, you may see both charges on the Explanation of Benefits (EOB) from your insurance carrier, as well as on our billing statement. In these situations, the payment made to AMC will never exceed what would have been paid had the claim been submitted for the Anesthesiologist alone.
You may see a comment on your EOB (Evidence of Benefits) stating that a portion of the total charge is not being allowed or considered for payment because it is above the Usual and Customary Rate (UCR). The UCR is usually determined by calculating the average charge for the procedure in question based on the geographic location of the hospital in which the procedure was performed. Theoretically, this might make sense; pragmatically however, the calculation falls short. The difficulty is that an insurance company typically obtains the UCR amounts from actuarial companies that have compiled their data based on a given timeframe. In other words, the data that is used is anywhere from six months to a year old in a best-case scneario. Physicians, like most people in business (including insurance companies), need to adjust their rates to keep pace with the economy. Since most physician groups raise their rates on at least an annual basis, the data that is used to determine the UCR is almost certainly outdated. Thus, not only does the patient have to pay an increase in monthly premiums but they are also held responsible for what is over and above the UCR allowed by their carrier. It is for this reason that we try to educate our patients and urge them to appeal to their insurance carrier for additional payment on their behalf.
AMC provides several payment options for you.
For interest free payment plans please contact Care Credit at (800) 365-8295 or online at www.carecredit.com.