- I accept payment from any insurance company (except Medicare, Tricare, and Medicaid) even if I am not in their network.
- I will bill your insurance company (except Medicare, Tricare and Medicaid) for my services, even if I am not in their network.
- You are responsible for the amount insurance doesn’t pay.
- For surgical services, advance payment is required.
- For office services, payment is requested at the time of service.
- My discounted, simplified fee schedule is published later in this article.
- I only have discounted contracts with a few insurance companies because most demand discounts that are too steep.
The medical payment system is unnecessarily complex and bewildering. I believe that one of the primary problems with healthcare in America is a lack of transparency in the system that pays for care. I have prepared this document in an effort to shed some light on this system. The typical sources for healthcare bills are medical professionals, hospitals, pharmacies, and home health agencies.
Professional fees include charges for office visits, x-rays in the office, surgical fees and in-hospital consultation fees. These fees include your medical doctor, surgeon, radiologist, pathologist and possibly an in-hospital internal medicine consultant. Additionally, a separate hospital bill will include numerous items such as room fees, orthopaedic implants, medicines, physical therapy fees and supplies. Many insurance companies have contractual discounts with professionals and hospitals.
Also, these same insurance companies have complex contractual agreements with patients (co-pay, deductible, in-network and out of network rules, out of pocket maximum). Neither patients nor physicians have much control over these contracts; insurance companies are in the position to pressure us into accepting these arrangements.
Therefore, determining your final cost in advance is extremely complicated. An insurance counselor in my office can assist you in estimating the likely cost for my orthopaedic professional services. We can also connect you with an advisor at the hospital to help you estimate the hospital expense, which is the most costly component.
The services I offer as an orthopaedic surgeon and joint replacement specialist are billed as professional fees in the following categories.
- Office visits
- X-rays in office
- Injections in the office
- Surgical fees
I have entered into contracts with a few insurance companies to treat patients covered by these plans for a discounted fee. I bill the insurance company my normal fee; they then disallow a certain percentage as the contractual discount which I am obligated to write off. As demands for my services increase, I will gradually drop these contracts. Generally, specialists with the least demand for their services feel compelled to sign contracts with more insurers at higher discounts.
Later in this document, I will provide detailed figures so you will be well-informed about costs before you choose me as a consultant and surgeon. First, I will provide a quick reference section to allow you to quickly estimate what your likely costs will be, depending on your insurance type. If you want to learn more about the whole system and how you fit into it please read the remaining sections.