Financial Considerations
In order to best serve the needs of our patients, The Stone Clinic is an out-of-network, fee-for-service provider.
We accept all major forms of payment, including CareCredit, at the time of your visit.
Monthly payment options are available through CareCredit. You may finance your treatment with manageable monthly payments ranging from 6 to 60 months. You may use the payment calculator to find out your options.
After your initial examination and before treatment, we suggest all patients contact their insurance carriers directly to obtain coverage information. Covered procedures will vary with each insurance company.
For your convenience, you will be given an itemized receipt when leaving the office, which you send directly to your insurance company for reimbursement. If you prefer, your surgical bills can be submitted to your insurance carrier by a third party billing service at no extra charge.
We have opted-out of Medicare, which means our services are not covered by any type of Medicare or Medicare supplemental insurance policies. However, Medicare and Medicare supplement policies often cover the facility and anesthesiology charges associated with surgery.
Please contact our office at +1(415) 563-3110, if you have any questions. We are always happy to help patients figure out the best financial option.
Frequently asked billing questions
What is the difference between an in-network provider and an out-of-network provider?
An in-network provider is one contracted with a health insurance company to provide services to plan members for specific pre-negotiated rates. An out-of-network provider is not contracted with the health insurance plan.
Why are you out-of-network? Why don’t you accept my insurance?
The Stone Clinic is an out-of-network provider, which means we are not contracted with any insurance companies and, therefore, do not bill insurance for our services. Contracted, or in-network providers, are only allowed to perform procedures that your insurance company has determined are the preferred method of treating your injury.
The guidelines of your specific insurance policy may exclude coverage for certain procedures, even when your physician or surgeon has determined they are the best option to relieve your symptoms and provide a long-term, successful outcome. We believe your surgeon should decide the best treatment for your injury or symptoms, not your insurance company. The Stone Clinic has chosen not to contract with any insurance companies in order to have the freedom to perform the most technologically advanced orthopaedic surgery procedures available and provide an exceptional patient outcome and experience.
Do you accept my insurance plan?
The Stone Clinic is an out-of-network provider, which means we are not contracted with any insurance companies and, therefore, do not bill insurance for our services. Our patients make payment-in-full for our services at the time they are received, then submit their own claims directly to their insurance companies for reimbursement. At the end of your consultation, we will provide you with an itemized receipt, which can be submitted to your insurance company for reimbursement.
For surgical services, we contract with a medical billing service that acts as a Patient Advocate by submitting surgical claims on your behalf and communicating with your insurance company to ensure you receive the highest possible reimbursement based on your out-of-network benefits.
If you have out-of-network coverage, you will be reimbursed directly by your insurance company according to your plan’s specific out-of-network benefits. To inquire about your specific insurance coverage, you may call the Customer Service phone number listed on your insurance card for a detailed explanation of your policy.
Are there monthly payment options?
Yes. You may finance your treatment with manageable monthly payments ranging from 6 to 60 months through CareCredit. You may use their payment calculator to review your financing options for treatment. (Note: Care Credit services are only available for U.S. residents).
Does The Stone Clinic accept Medicare?
We have chosen to "opt out" of the Medicare program. What this means is that you give up all Medicare coverage for services furnished by Kevin R. Stone, MD, and The Stone Clinic. You cannot bill Medicare or ask us to bill Medicare for any charges from our office. Medigap and other supplemental insurers may not pay either. However, please note that if surgical treatment is required, the surgery center and anesthesiologist will bill Medicare and any secondary insurance; these fees are typically paid by Medicare and supplemental insurance companies.
I've never billed my insurance company directly before. How do I do this?
At the end of your consultation, we will provide you with an itemized receipt, which can be submitted to your insurance company for reimbursement. The claims mailing address can be found on your insurance card. For additional information regarding claims submission requirements specific to your insurance policy, please call the Customer Service phone number listed on your insurance card.
What if my insurance company denies my claim?
Fax a copy of your Explanation of Benefits (EOB) to the attention of our billing manager at 415-563-3301. She will be happy to review the EOB to see if there is anything she can do to aid you in receiving additional reimbursement.
Should I send in my receipts after each date of service or should I wait until the end of my treatment?
The sooner you get your receipts to your insurance company, the sooner you will get reimbursed. Be sure to keep a copy of everything you submit. Or, if you prefer to wait until the end of your treatment, we can print out one form for you to submit with all dates of service on one sheet.
Your Rights and Protections Against Surprise Medical Bills
When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.
What is “balance billing” (sometimes called “surprise billing”)?
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.
“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay 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 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.
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 or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). 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.
California law protects patients enrolled in state-regulated plans from surprise medical bills when a patient receives emergency services from a doctor or hospital that is not contracted with the patient’s health plan or medical group. In covered circumstances, providers cannot bill patients for more than their in-network cost-sharing.
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 those providers may 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 services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.
You’re never required to give up your protections from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.
California law protects patients enrolled in state regulated plans from surprise medical bills when the patient receives scheduled care at an in-network facility such as a hospital, lab, or imaging center, but services are delivered by an out-of-network provider. In covered circumstances, providers cannot bill patients more than their in-network cost sharing. Further, for uninsured individuals, hospitals must provide the patient with a written estimate of the amount the hospital will require for the expected services at the time of service.
When balance billing isn’t allowed, you also have the following protections:
- You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.
- Your health plan generally must:
- Cover emergency services without requiring you to get approval for services in advance (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 deductible and out-of-pocket limit.
If you believe you’ve been wrongly billed, please contact the California Department of Managed Health Care at 1-888-466-2219 or www.HealthHelp.ca.gov.
For federally regulated plans, including “self-insured” plans and Medicare Advantage plans, please call 1-800-985-3059 or go to https://www.cms.gov/nosurprises/consumers.
Visit www.cms.gov/nosurprises for more information about your rights under federal law.
Visit www.HealthHelp.ca.gov for more information about your rights under state law.
You have the right to receive a “Good Faith Estimate” explaining how much your health care 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 1800-985-3059.