PATIENT FORMS & FEES

FEES & INSURANCE INFO

At SC Neuro, we like to keep patients and providers informed about financial costs of an evaluation and/or treatment at the earliest possible point in the pre-clinical or clinical relationship. The following information is meant to serve as a general set of guidelines, and not as absolute clinic policy. If you have further questions, please call our office at 843.509.6521.

If you have received a bill from us, and would like to make a payment, please click the button, below.

Insurance

We are in-network for most Medicare plans. We do not accept other, private insurances. You may, however, have a plan that pays out-of-network (OON) benefits. If you do, we will provide you with a “Super Bill” at the end of your evaluation, which you can then submit to your carrier for OON benefits. Please make sure to contact your insurance representative/carrier prior to scheduling an evaluation to determine whether or not they will pay for OON services; we cannot provide you with this information.

Good Faith Estimate

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost. Under the law, health care providers need to give patients who don’t have insurance, or who are not using insurance, an estimate of the bill for medical items and services.

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
Make sure your health care provider gives you a Good Faith Estimate in writing at least one (1) business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 843-509-6521.

Rates & Clinical Fees

There is an established rate of $250 per hour for each of the various clinical services we offer; however, this rate do not apply to you if you are covered by Medicare and if we are performing in-clinic (i.e., not in-home) services. Rather, this rate is meant to provide information about the maximum possible hourly rate for each service. Please do not hesitate to contact us with any payment-related questions.

Diagnostic interview, testing, feedback visits $250 per hour

Forensic evaluations are those that are attorney-based referrals, and not as part of necessary medical treatment following (for example) a sustained traumatic brain injury due to a motor vehicle accident. Fees for most legal/forensic evaluations are not covered by insurance. Please see the Forensic Evaluations section for more information regarding these specialty evaluations.

FORMS

Click to download:

• Patient Registration Form
• Notice of HIPAA and HITECH-compliant Privacy Practices
• Patient Referral Form

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