You’ve Been Told You Need Surgery. Now What?
No one wants to hear that they need surgery, which can be a major medical procedure that impacts physical and financial health. However, there are excellent tools and resources available to manage medical provider selection and surgical care options, so that cash pay patients can obtain the best care, at the best price. Sedera’s Medical Shopping Concierge service helps Members find value-driven prices on local providers and procedures and Sedera Members have access to Savvos, the nation’s largest cash pay marketplace for outpatient surgery and more.
Sedera Members know how important it is to shop for the best value when choosing providers and medical care to avoid inflated medical costs. Per our Member Guidelines, paying inflated amounts for medical services reduces the effectiveness of the cash pay approach and ultimately results in higher costs for the Sedera Community. As such, Sedera reserves the right to reduce sharing by up to 50% per bill for charges which exceed industry price norms. To avoid this we strongly recommend using Savvos to search for the best cash pay price for non-emergency surgery.
Savvos for Sedera Members can be accessed via the Cash Pay Resources on our website. Members who use Savvos may potentially have their IUA for surgery reduced. You can learn more about Sedera’s partnership with Savvos here.
Sedera Medical Cost Sharing Members are supported by a live team of experts who are there to help them every time they have a question, a concern, or need assistance. While planning for surgery can be stressful, there’s peace of mind in knowing that our Member Services team is available to help guide and support our Members through every step of their medical journey as cash pay patients.
Below are some important steps for Sedera Members to take when preparing for non-emergency surgery. As always, in the case of an emergency, seek immediate care.*
Step One: Call Member Services
Whether you’ve utilized Savvos to find a provider, or you’re still in the exploratory stage of selecting a provider, call Member Services so that we can answer any questions you have, help navigate the process, and assist you with opening a Need. It’s important to open a Needs Case as soon as possible to ensure that there is adequate time for you to connect with your designated Needs Coordinator prior to surgery. Your Needs Coordinator will provide you with confirmation of Sharing eligibility, as well as important information about what is needed to facilitate your Needs Case.
Step Two: Contact 2nd.MD
As outlined in the Member Guidelines, 2nd.MD is available as part of your Sedera membership and provides access to leading board-certified doctors that are experts in their field of medicine. Our Members are encouraged to contact 2nd.MD for a second opinion when a non-emergency, non-life-threatening surgery is recommended.
Consulting with 2nd.MD prior to non-emergency surgery and submitting the confirmation letter to your Needs Coordinator at least 7 business days prior to surgery, can reduce your IUA by $250.
To contact 2nd.MD, please call (866) 841-2575 and let them know that you are a Sedera Member and want to set up a free consult. You can also conveniently schedule an online consult on 2nd.MD/sedera. After completing a Medical Information Release Form, one of their doctors will review your medical history and either recommend surgery or provide you with alternative options. After the consult, ask 2nd.MD to email you your Consultation Summary and be sure to send this to your Needs Coordinator prior to surgery. Please keep in mind that the 2nd.MD process can take 7-10 days from start to finish.
Do I have to follow 2nd.MD’s recommendation?
Sedera Members are not obligated to follow the recommendations of 2nd.MD. However, 2nd.MD provides expert medical insight and potential options for less invasive treatments that may be available so that Sedera Members can make well-informed decisions about their medical care.
Step Three: Inform your provider that you are a cash pay patient
Always inform your provider that you are a cash pay patient to be billed directly with itemized invoices. There’s no need to mention Sedera or Medical Cost Sharing as doing so can sometimes complicate the billing process. Funds will be shared to your designated Account for Shared Needs either before or after surgery, depending on the amount of the required upfront payment, so that you can pay the provider directly.
Important questions to ask your doctor or billing office:
What is the minimum payment required upfront prior to surgery and the total cost remaining after upfront payment?
When is payment expected?
Are there any other providers that I need to talk to about surgery expenses?
What is the CPT code for this surgery?
At what facilities can you perform this surgery?
Is there a cash pay friendly surgery center in my area?
Be sure to confirm the answers to these questions within the first few days after surgery has been recommended to allow enough time for all the necessary steps to be completed. And remember, we recommend using Savvos to find the best provider at the best price for your procedure.
A few other important considerations
If Savvos is not utilized, there is the potential for costs to be negotiated, either before or after surgery, if it’s determined that the costs are inflated. For this reason, it’s important not to make large upfront payments to a provider that greatly exceed your IUA without speaking with your Needs Coordinator first.
Negotiations after surgery can take up to 90 days, so if it’s necessary, you can make the minimum payments on bills while they are being negotiated. Be sure to obtain itemized receipts for all payments you make and submit them to your Needs Coordinator as soon as possible.
The Sedera Community is here for you
As a cash pay patient, you are empowered to be a cost-conscious shopper and navigate your healthcare without being confined to provider networks. As a valued Sedera Member, you can have peace of mind in knowing that other Members of the Sedera Community are also committed to price shopping to facilitate the ability to meet Needs and keep monthly contributions low. And of course, Member Services is available to assist every step of the way. As one of our Members put it,
“I really like the customer service, especially being assigned a personal Needs Coordinator. It’s great to have a real person to count on. Thank you!” ~ Karen, CO.
Your Needs Coordinator will mainly communicate with you via email, so be sure to check your email regularly so that you don’t miss important action steps or updates. If you have any questions, you can also use the link in the email to book a call on your Coordinator’s calendar.
*SEDERA DOES NOT PROVIDE MEDICAL ADVICE. The information contained herein is for informational and/or educational purposes only and is not intended or implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.
