Here is our list of Frequently Asked Questions as well as our Answers and Solutions:
Question: "Why are you unable tell me what my insurer will pay for your services before I start?"
Answer: Many insurers appear to have only a few insurance products on the "Front end." However, in reality they have dozens of different plans that are customized for each company. Within companies they are also likely to pay higher-level executives' benefits in a more liberal manner than typical employees. Whether you agree if this is ethical or not it is the way they write these policies.
Solution: We would encourage you to contact your insurer in advance and ask them questions about your plan. Please note that we will help you through the process but only have so much control over what information you insurer will share at the onset of your treatment.
Question: What is the "Usual and Customary Fee (UCF)."
Answer: Many insurers typically will agree to pay for a certain percentage of out-of-network charges, for example, 80%. However, they will not pay 80% of your clinician's fee. They will pay for 80% of what they deem to be the "Usual and Customary Fee" or UCF. They define this to be the average fee charged by a particular type of health care practitioner within a geographic area. The term is often used by medical plans as the amount of money they will approve for a specific procedure. In our experience most plans grossly underestimate the market of clinician fees in the Boston Metro Area and set their UCF's very low.
Solution: We would encourage you to contact your insurer in advance and ask them questions about your plan's UCF for various procedures. Our staff can provide you with a list of the types of procedures that are charged during the course of your treatment that will include their procedure codes.