Update - June 24, 2016 :
New Federal legislation passed in 2015 has created a difficult environment for patients and medical providers. There is now a proliferation of less expensive insurance plans that meet the needs of the
ACA, which has possibly driven the emergence of narrower insurance networks. You as a patient may not have a choice or even be aware of the restrictions your insurance plan has placed on you. In order to contain cost and increase the profitability of insurance carriers, patients and medical providers are left with a difficult to navigate terrain of new rules and restrictions. There are now restrictions as to what provider you can access and the financial penalties associated with choosing a provider who is associated with your Hospital.
CPS is in-network with most providers, but there are now so many new insurance products (Bronze, Silver Plans, etc.) that may actually exclude certain providers from the network you can access. Considering the complexities of a surgery, it is difficult to accurately estimate the charges you will get from CPS Pathology providers, which depend on the type and number of tissue that will be removed at surgery. If your insurance carrier were to consider CPS an out-of-network provider simply because of the changes made to your particular plan, you may be requested to pay a higher out-of-pocket payment. We will work with your insurance carrier to determine a fair compensation for our services.
When you patient are purchasing an insurance plan that has a networks so narrow
that not all providers you will need are covered and in-network, you are not getting the benefit that you thought you bought. When a network covers a patient’s lab
services only through a commercial lab such as Quest or LabCorp, any lab or tissue exam done here at PRHS and our pathologist’s work doing
medical oversight at the PRHS hospital lab has to be billed to you.
But that is work that we should have been appropriately reimbursed by your insurance carrier as
part of your coverage. More often than not, your insurance carrier will choose not to partner with us or other Hospital providers in order to get a cheap result from a large out-of-state Lab. The exclusion of hospitals and physicians in many areas can have serious consequences for the cost of your care. In an area like Naples, where there are only two Hospital systems and no additional in-network providers available, your cost may significantly increase if performed by CPS, an accredited and exclusive provider of Pathology and Lab services for PRHS Hospital. The net result is that your blood sample or tissue examination may be performed by an unknown out-of-state provider, whose credentials and performance are not certified. In addition, results and reports will not be immediately available to your doctor and will not be part of the medical records we maintain at this Hospital. This ends up being a problematic situation for you as a patient, because you are receiving a product from a provider who has no relationship with the care you are getting at PRHS. But choosing to have lab tests and tissue examination done by PRHS Pathologists associated with CPS you know you will receive a quality result and allow your test results to be available to your doctor. The small cost associated with our service is necessary for the quality of your care.
We encourage you to contact your insurance carrier and explain that on-site pathology and Lab services provided by CPS Pathologists at PRHS should be a covered service and should be paid in full by your plan. You are still responsible for copay and deductible, which cannot be waived and we must bill to you. It is up to you as a patient to be more informed and request insurance carrier to compensate professionals involved in your care adequately and cover all necessary services with a fair reimbursement. Together we can control cost and increase the quality of your care without the dangerous discounts and network exclusions that insurance carriers are playing at the expense of patients and medical professionals.