What is IONM?
Intraoperative Neurophysiologic Monitoring (IONM) is used during surgical procedures that directly or indirectly involve the nervous system, or inherently place neural structures at risk.
In layman’s terms, we are the voice of your nervous system while you’re in surgery.
The integrity of these neural structures can be monitored using various techniques. The use of IONM helps identify changes in brain, spinal cord, and/or peripheral nerve function in order to prevent complications that could result in irreversible nerve damage.
Why is IONM necessary during surgery?
When an individual is undergoing a delicate procedure that involves working near critical nervous structures, the procedures inherently place your nervous system at risk. A surgeon partners with an IONM technician who monitors nervous structures during the procedure and works with the surgeon to minimize the risk of nerve damage.
BILLING QUESTIONS AND ANSWERS
Why are there two bills for Intraoperative Monitoring?
Our IONM services require some of the most advanced technology available, with an entire team of technicians and physicians working in concert with your surgeon to maximize efficiency and safety during surgery. In many instances, our IONM services create a bill for both the technical component (the services provided to you by the technologist in the operating or procedure room) as well as the professional component (the costs of a specialist neurologist who is continually monitoring, analyzing, and advising the surgeon or physician during the procedure.
The reason for this “double bill” for the professional and technical components of the neuromonitoring bill is that the Centers for Medicare and Medicaid (cms.gov) has opted to divide the service into the two billing components. While these services are billed separately from your surgical procedure, you will receive either a bill and/or explanation of benefits for the costs of these two related services. You, the patient, will not be responsible for beyond your deductible (if any), nor will we collect from you additional payments not covered and paid for by your insurance beyond this deductible. Occasionally, the insurance company will send payments for these services directly to you (a check) and this will need to be forwarded to our billing service.
Why do you have to bill?
As a matter of policy and federal law, we will forward a bill for services that were provided. Please feel free to contact our billing service with any concerns or needed explanations regarding information with your Explanation of Benefits (EOB) or insurance carrier statements. We will always work with you and address your concerns to your satisfaction whenever possible.
Your Rights and Protections Against Surprise Medical Bills
When you get emergency care of are treated by an out-of-network provider at an in-network hospital or ambulatory surgery center, you are protected from balance billing. In These cases, you shouldn’t be charged more than you plan’s copayments, coinsurance and/or deductible.
What is “Balance Billing” (Sometimes called “Surprise Billing”)?
When you see a doctor or healthcare provider, you may owe certain out-of-pocket costs, like a copayment, coinsurance, or deductible. You may have additional costs or have to pay the entire bill if you see a provider or visit a healthcare facility that isn’t in your health plan’s network.
“Out-of-Network” means providers and facilities that haven’t signed a contract with your health plan to provide services. Out-of-network providers may be allowed to bill you for the difference between what your plan pays and the full amount charged for a service. This is called “Balance Billing.” This amount is likely more than in-network costs for the same service and might not count toward your plan’s deductible or annual out-of-pocket limit.
“Surprise Billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care – like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider. Surprise medical bills could cost thousands of dollars depending on the procedure or service.
You are protected from balance billing for:
Emergency Services
If you have an emergency medical condition and get emergency services from an out-of-network provider of facility, the most they can bill you is your plan’s in-network cost-sharing amount (such as copayments, coinsurance, and deductibles). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.
Certain Services at an in-network hospital or ambulatory surgical center
When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most the providers can bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.
If you get other types of services at these in-network facility, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.
Your NEVER required to give up your protections from balance billing. You also aren’t required to get out-of-network care. You can choose a provider or facility in your plan’s network.
When balance billing isn’t allowed, you also have these protections:
- You’re only responsible for paying your share of the cost (like copayments, coinsurance, and deductible that you would pay if the provider or facility was in-network). Your health plan will pay any additional costs to out-of-network providers and facilities directly.
- Generally, your plan must:
- Cover emergency services without requiring you to get approval for services in advance (also known as “Prior Authorization”).
- Cover emergency services by out-of-network providers
- Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
- Count any amount you pay for emergency services or out-of-network services toward your in-network deductible and out-of-pocket limit.
If you think you’ve been wrongly billed or for more information about your rights under federal law:
www.cms.gov/nosurprises/consumers
1-800-985-3059
You have the right to receive a “Good Faith Estimate” explaining how much your health will cost
Under the law, health care providers need to give patients who don’t have certain types of health care coverage or who are not using certain types of health care coverage an estimate of their bill for health care items and services before those items or services are provided.
- You have the right to receive a Good Faith Estimate for the total expected cost of any health care items or services upon request or when scheduling such items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
- If you schedule a health care item or service at least 3 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 1 business day after scheduling. If you schedule a health care item or service at least 10 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after scheduling. You can also ask any health care provider or facility for a Good Faith Estimate before you schedule an item or service. If you do, make sure the health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after you ask.
- If you receive a bill that is at least $400 more for any provider or facility than your Good Faith Estimate from that provider or facility, you can dispute the bill.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises/consumers, email FederalPPDRQuestions@cms.hhs.gov, or call 1-800-985-3059.
