Payment & Insurance
Insurance and Medicare
Unlike most medical procedures, the healthcare system has not yet established a reimbursement rate or professional fee for doctors who perform breast cancer cryoablation. As a result, insurance companies have no obligation to reimburse doctors for the cost of performing breast cancer cryoablation and are free to reimburse doctors any amount the insurance company chooses, or not at all. Because of the uncertainty of insurance reimbursement for breast cancer cryoablation, we do not accept insurance for cryoablation procedures and are only able to offer cryoablation to patients who are able to pay out of pocket for the procedure. Following the cryoablation, we are happy to provide patients with documentation of their payment to us which they may use to seek payment reimbursement from their insurance company.
Our decision to restrict cryoablation procedures to out-of-pocket payments has come as a result of our desire to put your care first and to not deprive you of treatment options that are restricted by insurance company paperwork, contractual requirements, or inadequate insurance or Medicare/MediCal coverage or reimbursements. Sometimes new breast cancer treatment options become available to patients before the healthcare industry figures out a way to ensure that healthcare providers receive adequate payment to cover the cost of the procedure, essential equipment, and personnel. To ensure that you have direct access to a beneficial breast care treatment, Better Options Breast Care, Inc. provides an opportunity for you to receive care without going through your health plan.
Whereas Medicare has established a payment for hospitals to cover the cost of cryoablation equipment and supplies used in the hospital setting, Dr. Holmes performs cryoablation in a private office setting outside of a hospital and is unable to bill Medicare/MA for the cost of equipment and supplies. More importantly, there is still no Medicare/MA professional reimbursement rate for doctors who perform breast cancer cryoablation. Therefore, we must also require that Medicare/MA members pay out-of-pocket for the procedure.
Since Medicare/MA has not yet established an acceptable professional reimbursement rate for breast cancer cryoablation, doctors who request out-of-pocket payments from Medicare/MA members are required to have members complete an Advanced Beneficiary Notice of Non-Coverage (ABN) form before the procedure is performed. The ABN form requires that the doctor and patient reach an agreement on one of the following three options:
- Option 1: The patient will prepay for the procedure and the doctor will bill Medicare for the procedure. This option would require that the doctor accept whatever amount Medicare/MA chooses to pay (even if it’s only $200) and requires that the doctor provide the patient a full refund of her original payment. We cannot accept this financial risk or agree to this option.
- Option 2. The patient will prepay for the procedure and the doctor will NOT bill Medicare for the procedure. This also means that the patient can’t seek reimbursement from Medicare. Unfortunately, this is the only option we are able to agree to.
- Option 3: The patient declines the procedure, and the doctor cannot bill Medicare/MA in advance to see if and how much it would pay. This option means we cannot offer you the procedure.
For practical reasons, we are only able to offer cryoablation to Medicare/MA members who agree to Option 2, which also means that we cannot assist you with billing Medicare/MA for reimbursement. (Unlike private/commercial insurance, the ABN does not offer the option for the members to pre-pay and then seek reimbursement from Medicare/MA). However, if you have private/commercial insurance in addition to Medicare/MA, you may opt to seek reimbursement from the private/commercial insurer.
Paying Out-of-Pocket
Better Options Breast Care, Inc. welcomes patients as cash-paying individuals as an out-of-network provider. This payment model allows you to receive treatment directly, bypassing the limitations imposed by health plans. Payments can be made through various methods, including:
CareCredit: Managing Out-of-Pocket Expenses
For those needing assistance with out-of-pocket expenses, CareCredit offers a flexible solution. CareCredit is a healthcare credit card that helps manage medical costs not covered by insurance. With CareCredit, you can:
- Pay Over Time: Spread out payments for your healthcare expenses.
- Reusable Credit Line: Once approved, you can use CareCredit repeatedly for health, wellness, and beauty costs.
Learn more about CareCredit at www.carecredit.com or call 1-800-677-0718. Watch their video to understand how CareCredit can benefit you.
Clinical Trials: An Option for Financially Strained Patients
For patients experiencing financial hardship, participating in a clinical trial may be a viable option. Clinical trials often cover the cost of cryoablation and related medical care, provided you meet the trial's eligibility criteria and adhere to its requirements. Participants are generally not billed for the procedure.
Submit Your Case
We invite you to submit your case for a free case preview with Dr. Dennis Holmes. Our goal is to make the process as easy and accessible as possible, ensuring you get the information and support you need.
