Transparency in Coverage
The Transparency in Coverage Final Rules require certain group health plans to disclose on a public website information regarding in-network provider rates and historical out-of-network allowed amounts and billed charges for covered items and services in two separate machine-readable files (MRFs).
The MRFs available are not designed as a consumer tool. Members are encouraged to use the more member-friendly price estimator tools available through the health plan's public website. These files are not a guarantee of coverage, nor a guarantee of the reimbursement rate that will be applied for any procedure. The claims reimbursement process is subject to a variety of factors that are not addressed in these files, including eligibility, medical necessity determinations, utilization management requirements, exclusions and other plan terms. These files also do not offer any information on a member's out-of-pocket charges.
The MRFs for the benefit package options under the NuVasive, Inc. Welfare Benefits Plan are linked below: