David Nelson Hand Surgery Greenbrae Marin hand specialist surgery of the hand orthopedics San Francisco



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Insurance Plans

Plans Accepted

Dr. Nelson accepts Medicare, TriCare, Blue Cross, Blue Shield, Cigna, Aetna, PHCS, Interplan, and Worker's Compensation.

He does not accept United Healthcare. He does not accept Medi-Cal or Covered California policies that only pay the doctor a discounted rate. If you are covered by Medi-Cal or Covered California and cannot find a qualified doctor to treat your hand, call the office for advice.

He does not participate in HMO plans. "I do not participate in these plans because of the limits they place on me when I try to give you the best quality hand care. I don't want anyone placing limits on me when I am trying to provide you with the best healthcare that is possible. I have written an essay on this: please read Financial Incentives: Hard Facts for Patients."

If your insurance company wanted to make it easy for you to communicate with them, they would have designed the system differently. It is generally as clear as mud. However, information is power: if you don't understand how the insurance system works, you will not be able to get the best quality healthcare for yourself or your family. Read all of this page and all of Financial Incentives: Hard Facts for Patients. As I said, information is power. Put some time now into learning about your healthcare. - Dr. Nelson


How Insurance Plans Work

You need to know how your particular insurance plan works. To find out more about your insurance, look at your insurance card. There will be a number on the card to contact for more information. You will probably be connected to a recording, not a live person, and probably be placed on hold or be told to leave a number and they will call you back, but be patient and persistent. It is important that you get this information. Alternatively, you can call the health benefits coordinator at work (if you get your insurance through your work) or the health insurance broker (if you got your insurance through a broker). My office is not a good source of information on your particular insurance (for instance, how much is your co-pay? how much is your deductible? how much is your co-insurance?), since we don't know the financial details of your specific plan. For instance, you may have Blue Cross, but did you know that Blue Cross has thousands of individual policies that are negotiated with individual employers? It is simply impossible for us to know the financial details of all of the plans.

I can explain for you some terms that you may encounter:

Co-pay: this is the amount that you must pay for each visit, at the time of the visit.
Co-insurance: this is the percentage of the approved cost that you must pay.
Deductible: this is the amount that you must pay each year before your insurance company pays anything. This may vary with the service: office, hospital, or surgery.
"Usual, customary, and reasonable": This term is a great big fraud! It is a term made up by insurance companies to describe how much they will pay for a particular service. It is a fraud because the amount is not the usual amount charged by any doctor, it is not customary in that the amount has never been the amount charged by a doctor, and neither the patient nor the doctor think it is reasonable, and has been the center of many lawsuits for fraud. You see, the lower the insurance company sets this figure, they less they have to pay. And no one but them has any input into the figure! They would have to be financially crazy to set this figure very high, and they certainly are not financially crazy. The amount is often about 30% to 50% of the current charge by the doctors in any given geographic region (this kind of information is publicly available for a fee, in databases maintained by various companies; I get my information from MediCode in Salt Lake City, Utah.)
Global service period: this a the time period associated with a surgery, usually 90 days, during which there is no additional charge for follow-up by the surgeon. There is a charge for additional services such as xrays, casts, or splints, or for the management of any unusual followup services or for any complication. The duration of the global service period varies with the type of surgery and is determined by each insurance company, although they usually use the duration as set by Medicare.