Our office is one of the few FFS practices that is willing to work with insurance along with helping with appeals. We have been very successful in helping many patients overturn denials.
FFS is performed at two locations.
For self-pay or cash patients, surgeries are performed at a private joint commision accredited surgery center and a private 24 hr acute nursing facility. Neither of those facilities are contracted with insurance but for self-pay patients, the costs are cheaper than the hospital. Hospital cash fees are 2-3 times higher.
For insurance covered FFS patients, cases are usually performed at an in-network hospital such as Providence St John's Health Center in Santa Monica. Insurances can dictate where surgery can be performed especially if an HMO. Sometimes special letter of agreements needs to be obtained to perform surgery at an out of network facility.
For patients who are scheduled initially for self-pay surgery at the private centers, if insurance coverage does get approved, surgery needs to be moved to the hospital or insurance approved facility as the private centers are not contracted with insurance. That means surgery may need to be delayed or cancelled in order to move to an insurance approved facility. It takes several weeks to make that change depending on hospital operating room availability.
When using insurance, we do request a letter of agreement with the insurer to reimburse at our normal self-pay cash rate that every other patient pays which is fair. No one would accept 10 or 20% of the normal cost.
There is always two sides to every story and I cannot comment on any patient-specific details due to patient privacy laws.