Vein Procedures and Insurance: What You Need to Know
It is very common for patients to ask What will I have to pay out of my pocket? Insurance plans today can be very confusing, so let™s try to make it as simple as possible to understand. Since it is only natural that you would want to know what your responsibility is before you decide on any treatment, the following should help you understand your financial responsibility. It is important to note that you are responsible for knowing what your insurance covers and what it doesn™t. At The Boca Vein Center, we make every effort to help clear up confusion about insurance coverage for our patients. But remember, every insurance company has many different individual plans within the Network, so this is just a guide to help you work through some of the basic terms.
What is a deductible? Simply put, this is the amount that you have to pay before your health insurance begins to pay for anything. Deductibles only apply to those services that are considered covered by your plan (cosmetic procedures are not covered and the deductible does not apply). So, if the deductible on your plan is $1000, then you must pay out of pocket that amount before your insurance begins to pay out for services. Often, the amount of your deductible increases as the insurance premium decreases. For patients who do not have a lot of serious medical conditions, they may choose a high deductible plan in exchange for a lower premium payment.
What is a co-pay/Coinsurance? Co-pays are what you pay when you see a doctor or have a test or procedure done. This is a flat fee that can vary by insurance policy and can change for different physician specialties, facilities and procedures. Co-pays do not count toward your deductible, as a general rule. Coinsurance is a percentage of a provider™s charge (ie: 80%/20%, 70%/30%). This is the way you share the cost of your care with your health insurer. So if you have an 80/20 policy, then your insurance pays 80% but either you or your secondary insurance are then responsible for the remaining 20% of the cost. Medicare is an 80/20 program and this is why most people get a secondary insurance (ie: AARP, GHI, United Healthcare, etc) to cover the 20% that Medicare does not pay.
What is Out of Pocket? Out of Pocket is the most you will be responsible for during any one calendar year. For example if your maximum out of pocket is $5,000.00 for a calendar year, and due to a hospital stay your charges are $10,000.00, you will only be responsible for the $5,000.00 and the insurance will pay the balance. This applies to outpatient/office procedures as well, so if you have not met your maximum out of pocket, you may be responsible for some of the charges.
When in doubt about what you will be required to pay, always call your insurance carrier. If you can get the CPT (procedure being done) and ICD (diagnosis) codes from the physician™s office, it will be much easier to get the information that you need on your financial responsibility. Give these codes to the person you call at your insurance company™s customer service department, and they should be able to tell you what you will be responsible for. At The Boca Vein Center we encourage our patients to be pro-active with their insurance carriers. While there are some things that we can do to help, most often it is up to the patient to make the call for benefits to determine what they will be responsible for. If you have questions, we are happy to try to answer them if we can, but your best source of specific information will come from your own insurance plan service department. (see the toll free number listed on your card).
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I can’t say enough about this doc. He goes above and beyond the scope of the usual doc. Will do anything he has to do to accomplish the best outcome. I can’t say enough about him and his staff
Having developed varicose veins at a young age and watching a family member go through the procedures multiple times with more than one doctor and little success, my experience with Dr. Kimmel and his staff was outstanding. The large bulging veins (that kept me out of shorts in the hot Florida sun) and the achiness/itching in my legs is gone. I had one session the resolve my spider veins as well which is proving to be equally successful. I would highly recommend Dr. Kimmel for anyone who needs to have this procedure done. And Melissa, Julie, Clara and other staff were excellent, professional, honest and great at what they do.
I went to Dr Kimmel for varicose veins. I had been to other doctors in the past and he is by far the most thorough and knowledgeable doctor I have been to. He treats the underlying issues first which many doctors do not. His staff is also fantastic. Professional, knowledgeable and kind. If you need a vein doctor, do not go to anyone but him. Too many people advertise themselves as “vein treatment centers” and don’t know what they are doing. Dr Kimmel is truly a doctor who specializes in vascular issues and was great. Highly recommend
From the first visit to the last I was very satisfied with the doctor and his wonderful assistant, nurse and staff. The words to use, caring, professional and answered all my questions clearly. I would definitely recommend Dr, Kimmel to my family and friends. The doctor explained what he would do for the veins on my legs and the procedure. It has only been 3 weeks and my legs have improved so much & will continue to do so.Very positive experience.
I have just recently had the laser vein procedure on both of my legs done for extremely heavy various veins at the Kimmel Institute and cannot tell you how happy I am with the results. Dr. Kimmel and all of his staff were wonderful, professional and I couldn’t have asked for a better experience. I found Dr. Kimmel on the internet and started researching him and came up with only positive findings. I was still a little nervous about finding a doctor on the internet but when I called the office and came in for the initial screening, I knew I was in the right place. Check him out for yourself and I know you will be a happy as I am. Thank you, Dr. Kimmel and staff!
Dr. Kimmel and his Staff are an unbeatable combination of knowledge, expertise and Tender Loving Care. I enjoyed a truly positive experience from beginning to end…could not be happier with the results. Go… Kimmel Institute!
Richard Kimmel is the BEST. I had an extremely wonderful experience. Julie & Melissa really made it brainless for me. I highly recommend. Anyone that does not use him in my opinion is a fool. He is really that great. You won’t be disappointed. If there were more “stars” I would give it to Dr. Kimmel and his wonderful staff.
I called the office and new I found the right place. My first visit and consultation confirmed that. It was such a pleasure to be treated like I was their PRIORITY, not just another patient passing through. They answered all my questions and I felt comfortable asking them. The staff was very friendly and knowledgeable; truly an experience like this is hard to find these days. Oh, and by the way…my legs look and feel GREAT!!! Highly recommend!!!
I underwent an ambulatory microphlebectomy,a chemical ablation and sclerotherapy with Dr Kimmel. He is a professional efficient surgeon. The whole staff especially Melissa and Clara are wonderful as well. They all create a calming atmosphere while the procedures are being performed. I have never been to an office where everyone shows they care about you. This is that type of place that Dr Kimmel has.
About The Kimmel Institute
We are committed to professional excellence in everything we do.
Our care has been refined by more than two decades of serving the community as a private practice.
Dr. Kimmel is nationally recognized as a leader in the field of vein care.
We act as a center of excellence, providing laser training for surgeons around the country.
All treatments are performed by top notch, licensed, and certified medical specialists.
The Kimmel Institute:
1905 Clint Moore Road Suite 215 Boca Raton, FL 33496