Understanding Billing After Your Visit
Summary
Manhattan Pain Medicine describes its out-of-network billing workflow and how patient insurance benefits are processed. The practice collects an estimated cost share deposit at the visit based on pre-appointment coverage details. Following care, claims are submitted to the patient's insurer, and the billing team coordinates directly with insurance companies or drug savings programs to resolve claims. Once insurance payments process, accounts are reconciled, and any remaining deposit balance is refunded to the patient.
Conditions and treatments discussed
- Out-of-network care model. The practice operates out-of-network to allow physicians to base clinical decisions on individual patient needs rather than insurer contracts.
- Insurance claim submission and reimbursement. The billing team submits claims on behalf of patients, negotiates with insurers, and reconciles cost share deposits after processing.
What this shows about Manhattan Pain Medicine
In this video, Manhattan Pain Medicine emphasizes patient education by walking patients through the financial and administrative steps of out-of-network care. The practice explains how pre-visit insurance estimates, cost share deposits, claim submissions, and account reconciliations are managed on behalf of patients. Separate from this post, the practice also describes a diagnosis-first approach in which clinical evaluation precedes any treatment plan. By explaining how insurance negotiations and medication savings programs function, the practice outlines how administrative workflows support patient care while preserving physician decision-making.
Full transcript (264 words)
At Manhattan Pain Medicine, we're an outof network practice. This means we don't have contracts with insurance companies, allowing our physicians to make clinical decisions based on what's most appropriate for your care. But being out of network doesn't necessarily mean your insurance won't help cover the cost. If your plan includes out of network benefits, our billing team will submit claims to your insurance company on your behalf. Here's how the process works. Manhattan Pay Medicine has its own fee schedule, while your insurance company determines how much it will reimburse for covered services.
Whenever possible, we obtain information from your insurer before your appointment to estimate what insurance may pay. Based on that estimate, we collect your anticipated portion called a cost share deposit at the time of your visit. It's important to understand that this is an estimate, not necessarily your final financial responsibility. After your visit, we submit the claim to your insurance company. Insurance may reimburse the claim as expected, pay less than anticipated, or deny certain services. Our billing team reviews the outcome and when appropriate, works directly with the insurer to negotiate additional payment and help minimize your out-of-pocket costs.
For eligible medications, we may also pursue manufacturer savings programs to further reduce your expenses. Once insurance and any applicable savings programs have processed their payments, we reconcile your account. If your deposit exceeds your final financial responsibility, the difference is refunded to you. Throughout this process, our dedicated team works behind the scenes on your behalf, helping you navigate insurance and minimize your expenses wherever possible.