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Seeing patients in the offices of

Wise County Medical & Surgical Associates

1001 W. Eagle Dr.

Decatur, Texas 76234 

Understanding Out of Network Status

It has become all too clear that insurance companies are attempting to control the who, what, when, where, and how all Americans receive medical care. They refer to it as Managed Care, or a Healthcare Plan. As someone who has watched this systematic seizure of healthcare decision making for more than 40 years, I choose not to allow any third party to come between me and the patients I am sworn to serve. That is why nearly 20 years ago I opted out of any and all insurance contracts, choosing instead to work directly for my patients. I am what is known as an "Out of Network" healthcare provider. The insurance companies have not made that easy for me and other OON physicians, or for our patients, because allowing patients to go outside their closely controlled provider networks means they must relinquish control back to the patient. To them, healthcare financing (insurance) is a business, and the more elements of that business they can directly control, the more profitable they can be.

Recently, the insurance industry joined with consumer protection groups in successfully lobbying the Texas legislature to pass a new law entitled the "Surprise Medical Billing Law" which prevents patients from being billed for the difference between what an Out of Network provider charges and what an insurance company elects to pay. The principle behind this law is to prevent patients from receiving surprise bills when they expected their insurance would cover their medical expenses, and I absolutely agree with that goal. It has always been my practice to tell patients, upfront, exactly what my fees are and if they decide to seek their care elsewhere they are free to do so. However, this new law requires every patient to sign a Texas Department of Insurance form at least ten days prior to receiving treatment, acknowledging the anticipated fee to be charged by the Out of Network provider, and emphasizes their right to seek an In Network provider, which may be recommended by their insurance company. (See the TDI Form)

It is my firm belief that no one should undergo any treatment or testing without knowing what it is going to cost. You wouldn't, and shouldn't, purchase any goods or services without asking "how much" ahead of time. That is why I have posted my professional fees for the most common procedures I perform right here on this web site (See Our Fees). However, the two issues I have with the new law are (1) the rather threatening wording contained in the TDI form, and (2) the ten day advance notice requirement. The way the form reads it makes it seem as though you are relinquishing any and all rights as a patient if you sign the document. It is clearly designed to discourage anyone from agreeing to an Out of Network provider. Likewise, the 10 days requirement does not allow for patients to undergo treatments in an expedited manner by an Out of Network provider. 

I agree with the spirit of this new "Surprise Medical Billing Law" and despite the objections listed above, I will make every effort to also comply with the letter of the law. My first goal is to provide the best care I can to each and every individual who entrusts me with that solemn duty as stated in my Mission Statement

Offered respectfully, 

Robert Sewell, MD, FACS

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The Surgical Practice of Robert Sewell, M.D., F.A.C.S.

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