Billing & Insurance
We believe in transparency. Here's everything you need to know about how billing works at Novus as an out-of-network practice.
We thank you for entrusting us with your health needs. We understand how insurance paperwork can sometimes appear confusing or even alarming, and we'd like to take a moment to clarify the billing process, expected statements, check endorsement instructions and policies in an out-of-network setting.
When medical services are provided, each procedure is assigned a standardized CPT code (Current Procedural Terminology). These codes are universal and required by law. Once entered, the system automatically generates the cost based on geographical region — in this case, New Jersey. These rates are not set by our practice, but rather by national billing standards and CMS guidelines.
In-Network
Providers bill a contracted (often lower) rate, but insurance also reimburses at a lower rate. For example, if a provider bills $100, the insurance may only pay $25–$50, leaving the patient responsible for the balance or copay.
Out-of-Network (Novus)
Out-of-network providers must bill the full standardized rate. For instance, a $500 charge might result in insurance covering $200–$250. What is reflected on the insurance EOB is not necessarily what the patient owes.
Important: By law, medical services cannot be performed without being billed through insurance. It is not compliant — and in fact is against federal and state regulations — to render medical services without appropriately billing them.
With the nationwide transition from ICD-9 to ICD-10 coding in 2010, certain services — such as those performed on each foot — must now be billed separately. This is a compliance requirement and not something our practice has the ability to adjust.
We want to reassure you that we have an indigency policy in place to help protect our patients from excessive out-of-pocket costs. The only requirement is that insurance checks are endorsed over to the practice, ensuring you are not personally liable beyond what your plan requires.
Our indigency policy protects you from excessive out-of-pocket costs
Simply endorse insurance checks over to the practice
You are not personally liable beyond what your plan requires
An Explanation of Benefits (EOB) is a document that comes directly from your insurance company — not from our practice. The EOB explains how your insurance processed a claim, including what was covered, what was paid, and if there is any remaining balance.
In some cases, insurance companies send payment checks made out in the patient's name instead of sending them directly to our office. These checks must be endorsed and forwarded to our practice so the payment can be applied to your account. If these checks are not endorsed and returned, the balance may remain outstanding.
From Your Insurance
Explanation of Benefits (EOB)
Shows how your claim was processed, what was covered, and what was paid.
From Our Office
Office Statement
Shows payments issued by your insurance. Includes a pre-postaged envelope if a check needs to be forwarded.
We believe in full transparency regarding costs. Here's what to expect as a patient at our out-of-network practice:
Your first visit includes a comprehensive evaluation. We will verify your insurance benefits and explain your estimated out-of-pocket responsibility before any procedures are performed.
Under the No Surprises Act, you have the right to receive a Good Faith Estimate of expected charges for scheduled services. We provide this in advance so there are no surprises.
We accept all major credit cards, HSA/FSA cards, and offer payment arrangements for qualifying patients. Our team will work with you to find a solution that fits your needs.
Free Benefits Verification: Call (844) 668-8773 and our team will verify your out-of-network benefits at no charge before your first appointment.
The amounts are standardized CPT codes generated based on your geographical region (New Jersey). These rates are set by national billing standards and CMS guidelines — not by our practice.
No. The EOB shows the billed charge versus what insurance chose to pay. Under our indigency policy, you are not personally liable for the difference as long as insurance checks are endorsed to our practice.
Endorse the check (sign the back) and forward it to our office. We include a pre-postaged envelope with your statement for convenience.
Under ICD-10 coding (since 2010), services performed on each foot must be billed separately. This is a compliance requirement.
If checks are not endorsed and returned, the balance may remain outstanding on your account and could eventually be subject to collections.
We are an out-of-network practice. We bill your insurance on your behalf, and most plans provide out-of-network benefits. Our team can help verify your coverage.
Have billing questions?
Our team is always here to answer questions and assist you in navigating your insurance coverage.