A. “In -network” vs. “Out-of-network”
I do accept payments on your behalf from any private insurance company. I will be happy to pre-certify the surgery and bill your insurance company. If I have a contract to provide my services to an insurance company at a discount, I am “in-network”; if I do not, I am “out of (their) network”. If I am considered “in-network” for your health insurance company, please see section (B.); if I am “out of network for your health insurance plan, please see section (C.) below.
B. Standard fee schedule
- Insurance discounts may be applicable.
- This option applies to all patients who are covered by insurance companies with which I have a contract. I am “in network” for these plans.
- You pay only what is required by your plan. I receive the portion of the rest of my standard fee schedule from your insurance plan. I have agreed to provide my services to them at a discount.
- If I do not have a contract with your insurance company (I am “out of network” with your plan).
C. Discounted, simplified fee schedule
- Applies to Medicare, Medicaid, Tricare and Workers Comp. With these insurers, you are responsible for my bill and cannot submit it to your government insurance plan or to most Medicare supplemental policies.
- Any patient who has a private non-government insurance company for which I am “out of network”
|New Problem: Usual||$150.00|
|New Problem: Complex||$200.00|
|Follow-up Visit: Usual||$ 50.00|
|Follow-up Visit: Post-op (within 3 months)||free|
|Follow-up Visit: Complex||$100.00|
|Follow-up Visit: Lee Webb, NP||$ 25.00|
|Injection or aspiration (any joint)||$ 50.00|
Depending on the nature of the evaluation and whether right and/or left sides are included, 3-13 images may be required. The total charge equals the number of images x $50. Typical examples are included below.
|X-ray per image||$50.00|
|Hip: New evaluation (3 images)
Hip: Follow-up, one side ( 2 images)
Hip: Follow-up, two sides (3 images)
|Knee: New evaluation, one side (4 images)
Knee: New evaluation, two sides (7 images)
Knee: Long alignment, one side (3 images)
Knee: Follow-up, one side (3 images)
Knee: Follow-up, two sides (6 images)
|Other: generally require 2-3 images||$100.00 -- $150.00|
|Retakes due to poor image quality||$0.00|
These fees will be quoted to you in advance of surgery and are firm quotes. If the operation becomes more complicated than I anticipated, no extra charges will apply. The operation types are grouped in only a few categories to keep it simple.
First-time total hip replacement, total knee replacement, partial knee replacement or hip surface replacement (in most cases)
Simple revision surgery
Hip impingement surgery
Any of the surgeries above in severely obese (BMI≥35) patients or patients with underlying difficult deformities.
Usual revision surgery
Hickman catheter removal
|Surgical Assistant||Included in fees above|
Complications may require repeat surgery, which will be billed separately. Revision surgery is more prone to complication. Treatment for an infection will often require two or more difficult and/or complex procedures. Some portion of surgical fees must be paid in advance. The amount depends on your insurance type. Office visits, injections and x-rays are payable at the time of service. Credit card is accepted. Late payment will result in a 20% surcharge.