By: G. Keith Smith, M.D. http://SurgeryCenterOK.com
A patient who wanted to have a procedure at our facility asked us to file insurance. We discovered that if she had her surgery at our facility rather than at an “in network” hospital, her deductible would have been $3,000 instead of $1,500, her copay would have been 50% of the charge rather than 20%, and she had to agree to a 25% penalty for coming to the Surgery Center of Oklahoma rather than one of the hospitals in the network. Never mind that the hospital would receive multiples of our fee from the insurance company, and the patient’s copay at the hospital was more than our entire charge.
This insurance company (a huge national company) made it clear when they came to Oklahoma that they were not interested in contracting with any facilities that were not hospitals or affiliated with hospitals. Because of this, our facility is out of network. In order to steer patients to in-network facilities, insurance companies financially punish patients for wandering outside.