Insurance, Prior Authorization & Self-Pay

01 · The NuSelf commitment

Clear pricing, clear inclusions, and help navigating coverage.

NuSelf believes patients should understand the financial plan before scheduled care. We will explain the services NuSelf controls, disclose the information available to us, identify known inclusions and exclusions, and help you navigate benefit verification and authorization requirements.

Our self-pay surgical packages are designed to be competitive and transparent. Each written package identifies the professional or facility components included, services that remain separate, payment timing, and circumstances that may change the final amount.

02 · Start here

Know the few terms that shape most out-of-pocket costs.

A premium is what you pay to keep coverage. A deductible is the amount you may need to pay for covered services before the plan begins sharing costs. A copayment is a fixed amount for a service, while coinsurance is a percentage of the allowed amount. An out-of-pocket maximum limits certain covered, in-network costs during a plan year but may not include premiums, noncovered services, or out-of-network amounts.

Network status matters because a plan can apply a different deductible, coinsurance, or balance-billing rule outside its network. Never assume that an in-network office means every related facility or clinician is also in network.

03 · Before the visit

Confirm what your plan requires for a specialist consultation.

Provide the exact name, member number, group number, and claims information from the current insurance card. Tell NuSelf if the plan, employer, or coverage changes. Some plans require a primary-care referral before a specialist visit; others allow direct scheduling.

Ask your plan whether NuSelf and the requested physician are in network, whether a referral is required, how a specialist office visit is covered, and what deductible or coinsurance remains. Record the date, representative, and reference number for the conversation.

• Is this physician in network under my exact plan?
• Do I need a referral before the consultation?
• Is telemedicine covered differently from an office visit?
• What deductible, copayment, or coinsurance applies?
• Are second-opinion visits or out-of-area services handled differently?

04 · Before testing or treatment

Prior authorization is one step in coverage, not the final bill.

A plan may require clinical notes, imaging, documented symptoms, previous treatment, or medical-necessity criteria before approving a test or procedure. NuSelf can submit information it holds, while you may need to complete plan requirements or obtain outside records.

Authorization can be limited to a procedure code, physician, facility, and date range. If the plan changes or the procedure plan changes, a new review may be needed. Approval does not override deductibles, coinsurance, exclusions, network rules, eligibility on the date of service, or the plan’s final claim review.

05 · One procedure, several services

Understand which organizations may send a bill.

A surgical episode can involve the professional work of the surgeon, the hospital or ambulatory surgery center, anesthesia, pathology, laboratory testing, imaging, medications, durable equipment, and assistant services. Each organization may have its own network status, estimate, statement, and payment process.

Ask for the names of the expected billing entities once the facility and procedure are known. Contact your plan and the relevant organizations for estimates. Clinical changes can alter the final services, so an estimate is not always the final bill.

• Surgeon or professional fee
• Hospital, surgery-center, or office facility fee
• Anesthesia professional charges
• Pathology or laboratory services
• Imaging, testing, medicines, or equipment
• Assistant surgeon or other clinically necessary services when applicable

06 · If you are not using insurance

Request a written estimate and ask what it includes.

If you are uninsured or choose not to submit the care to insurance, ask for the self-pay policy and a written good faith estimate. Under current federal rules, uninsured or self-pay patients generally have a right to a good faith estimate when scheduled care is requested or arranged far enough in advance. Keep the estimate so you can compare it with later bills.

NuSelf will identify the services included in its written package and the services billed separately, which may include facility, anesthesia, pathology, imaging, laboratory, or other care. Ask what could reasonably change the amount, when payment is due, and whether another organization requires a separate deposit.

07 · Financing & payment plans

Review available options securely, then apply from your portal.

Available financing and payment-plan options are presented inside the secure patient portal, where you can review current terms and apply directly. Options, eligibility, approval, rates, and payment terms depend on the participating provider and the individual application.

Use the portal rather than ordinary email for application details or patient-specific financial information. The NuSelf team can help you identify which published option connects to the care plan being discussed.

08 · If a charge surprises you

Compare the statement with the plan, estimate, and explanation of benefits.

An explanation of benefits is not a bill. It shows how the health plan processed a claim, including the billed amount, allowed amount, plan payment, and stated patient responsibility. Compare it with the provider statement before paying.

If something appears wrong, ask whether the claim was coded or processed as expected, whether a referral or authorization was missing, and whether an appeal or corrected claim is appropriate. Federal protections may apply to certain unexpected out-of-network bills and to qualifying self-pay bills that substantially exceed a good faith estimate. Rules and deadlines can change, so use current information from your plan and the Centers for Medicare & Medicaid Services.

09 · Before you commit to a date

Use one financial checklist for the entire episode.

• Confirm surgeon and facility network status with the health plan.
• Ask whether authorization, a referral, or documented prerequisites are required.
• Request estimates from each expected billing organization.
• Ask how deductible, copayment, coinsurance, and out-of-pocket limits apply.
• Confirm the payment or deposit policy and accepted methods.
• Keep authorizations, estimates, reference numbers, and explanations of benefits together.