Financial Considerations

Physicians with the Mount Sinai Doctors Faculty Practice participate in most insurance plans. However, it is always wise to check with your physician’s office when scheduling your appointment to ensure that you will not encounter problems with your carrier.

We summarize below some important issues about insurance and managed care that, if neglected, can cause confusion and distress. In general, you are responsible for charges not covered by your individual insurance plan.

Check with your insurance carrier
Your physician may not necessarily accept every plan that a particular insurance company offers. If you are unsure whether your doctor accepts your plan, call your insurance company. Verify the physician’s status before your visit. If your doctor does not accept your insurance plan, the bill will be your responsibility.

Generally, all Mount Sinai physicians accept Medicare for covered services. This means that Medicare will pay 80 percent of Medicare-approved amounts, with the exception of certain services, such as clinical lab tests, which will be paid at 100 percent of the approved amount. Typically, this leaves 20 percent that must be covered by supplemental insurance or paid by you. In addition, an annual deductible must be satisfied each calendar year, and some Medicare plans have additional co-pays or deductibles that must be paid by the patient. Under federal law, physicians are not allowed to write off these Medicare expenses.

Our anesthesiologists participate in most insurance plans. Although in most cases, insurance that covers your surgeon will also cover your anesthesiologist, plans can vary greatly. If you will require surgery, it is best to contact the Department of Anesthesiology to determine whether your anesthesiologist accepts your insurance.

Laboratory tests
Any laboratory tests that your physician may order during your office visit will be billed separately. Mount Sinai Laboratory participates in most insurance plans and will charge your insurance company directly. However, you will be responsible for applicable co-insurance and deductibles.

If your physician takes a biopsy, obtains a Pap smear, or collects a fluid specimen, these samples are sent to the Icahn School of Medicine Pathology Laboratory for analysis. Results of these tests require interpretation by a pathologist — a physician who specializes in laboratory medicine. As with laboratory tests, pathology services are billed separately from your office visit. Mount Sinai pathologists participate in most insurance plans. However, some HMOs may exclude our laboratories from their networks. Check with your insurance provider to find out if any co-payments or deductibles may apply to these laboratory services.

If your physician requests a radiology exam, please contact your insurance company to determine whether you require a referral. Radiology Services will send you a separate bill that may carry the name of a physician you do not recognize. This physician processed, read, and interpreted your test. Unless prior arrangements are made, test results are sent to the referring physician, not directly to the patient.

Emergency services
If you receive treatment from the emergency department, expect to receive two separate bills — one from Mount Sinai Hospital, and another from Emergency Medicine Associates. The latter will represent the fee for the professional services that physicians provided you during your visit.

For Faculty Practice billing inquiries, please call 212-987-3100 (Monday-Friday, 8 am – 6 pm).