Orthopedic Surgery San Diego Financial Policy
Welcome to Our Office
We are dedicated to providing you with the best possible care and service, and we regard your understanding of our financial policies as an essential element of your care and treatment. If you have questions about your account, charges, insurance or payments, please speak with one of our billing representatives at (760) 573-4411. Otherwise, you are welcome to call our office for any general questions or needs at (760) 994-2663 (BONE). Please have available at the time of your visit the following insurance and identification information:
- Your insurance identification card.
- Your driver’s license.
- Credit Card.
- Your referral or authorization for services when applicable.
Billing Process and Credit Card on File:
I understand that Orthopedic Surgery San Diego agrees to bill my insurance as a courtesy. The anticipated patient portion of all fees for services provided (copay, deductible, cost share, coinsurance) are collected at the time services are rendered with the credit card on file.
This policy entails patients to provide a credit card to our office that is maintained securely. This credit card is used to pay account balances after insurance adjudication; this is the balance that your insurance carrier has deemed the patient’s responsibility (copay, deductible, cost share, coinsurance).
Insurance companies will deny payment if any information is not current. They will also deny payment if information is not submitted correctly within a certain amount of time. Please notify us of any changes in insurance, address or phone numbers. We will ask you about such changes at each clinic visit.
Many of our services are one-on-one (ie, no double-booking); which means missed appointments are lost revenue for the office and missed opportunities for other patients to be treated when needed. A charge of $40 will be applied for appointments that are not cancelled or rescheduled with at least 24 hours notice.
You may incur an additional expense for the following services: copying of medical records, copy of x-rays, form completion.
We cannot accept HMO insurance plans. We are contracted providers (in network) with many PPO health plans, not all. Please contact your insurance directly to be certain that Orthopedic Surgery San Diego (EIN 27-5562601) and the particular provider you are seeing is in your provider network; this is important.
In so doing, please verify coverage and discuss your benefits, co-insurance, and deductible specifically with regard to coverage when seeing a provider at Orthopedic Surgery San Diego. Unfortunately, we are unable to answer questions regarding such coverage and will direct you back to your insurance carrier. As contracted providers with insurance plans, we have agreed to accept certain payment amounts for most services that we provide. The provider cannot waive copayments, deductibles, coinsurance or other amounts you are responsible to pay under your health plan.
For patients with a PPO policy, you have the right to use a participating or nonparticipating provider
for your care. You have the right to use a participating provider and your in-network benefits for the entire in-office treatment. If we are not contracted with your PPO insurance, we can still provide medical care to you and your family as out-of-network providers. This means that we don’t have predetermined negotiated rates for services with your carrier. If that is the case, your fees will be on-par with what many insurance carriers pay for in-network services. We encourage you to contact your insurance carrier to determine your plan’s out-of-network benefits, to see what they will cover. We are happy to bill your insurance, but you are ultimately responsible for all charges incurred regardless of insurance payment. As with all out-of-network providers, there will be a difference between our charges and the amount that your insurance pays. Any balance remaining after insurance payment is due from you within 30 days. Keep in mind that this balance payment and all treatment we recommend will be eligible for reimbursement from health savings or flexible spending accounts.
We also welcome families with HMO or those choosing not to use medical insurance. Payment is due at time of service. We accept cash, Mastercard, Visa, American Express, and personal check. For any billing questions, please call (760) 573-4411 or email firstname.lastname@example.org.
Any service from an outside specialist, laboratory, advanced imaging (ie MRI), emergency department, hospital, or any facility other than Orthopedic Surgery San Diego is a transaction between you and them. It is your responsibility to know your insurance coverage prior to these appointments. You are financially responsible for any services they provide to you.
Your provider may have a financial interest in, or may benefit from, the various diagnostic and/or treatment measures/modalities offered at Orthopedic Surgery San Diego. Some aspects of the treatments/services may not be covered by your particular insurance plan. If the provider and/or recommended services are not contracted with or covered by your particular insurance plan, the following may apply. Services provided by the provider will be treated as out-of-network. If you have out-of-network benefits, you will be responsible to pay your share of the out-of-network costs, based on your benefits. If you do not have out-of-network benefits, you will be responsible for the full cost of the services provided. If you do not have out-of-network coverage, your carrier may deny the claim for the services provided. This means that you will be responsible for any charges not covered by the plan. If that is the case, your fees will be on-par with what many insurance carriers pay for in-network services. We recommend you take this opportunity to contact your carrier before obtaining these services to confirm your benefits and to obtain/confirm names of participating providers. Keep in mind that this balance payment will be eligible for reimbursement from health savings or flexible spending accounts.
Your physician with Orthopedic Surgery San Diego is a participating Medicare provider. We will bill Medicare and a supplemental insurance if you have one. At times, treatment recommendations may include durable medical goods and other services that are not be covered by Medicare from our office. You have the option of receiving a prescription for the device and procuring it elsewhere as a covered service or immediately being fitted and paying out of pocket for the device.
Third Party Liability Injuries
For patients who have been involved in a liability/third party accident, payment in full is expected at the time of service.
If you are involved in an “on-the-job” work injury, prior to seeing the physician the following information must be obtained and verified prior to your visit:
- Date of injury
- Case or claim number
- WCAB# if applicable
- Workers’ Compensation insurance carrier information
- Adjuster’s name
- Adjuster’s telephone number
Orthopedic Surgery San Diego also provides sports physicals on a walk-in basis at a self payment of $40.00 at the time of the physical (you must bring your sports physical form), between the hours of 9:00 AM – 11:00 AM and 1:00 PM to 4:00 PM. Please call before coming in to ensure that there is a physician available.