I. General Introduction

updated 10/8/2023 tpg

  • I accept payment from any insurance company (except Medicare, Tricare, Workers Compensation, and Medicaid) even if I am not in their network.
  • I will bill your insurance company (except UHC, Medicare, Tricare, Workers Compensation, and Medicaid) for my services, even if I am not in their network.
  • I am only contracted with Blue Cross and accept their contractual rates.
  • Out-of-state Blue Cross also is handled under contracted rates.
  • 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 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, and surgical fees. These fees include your medical doctor, surgeon, anesthesiologist, radiologist, pathologist, and possibly an in-hospital internal medicine consultant. Additionally, a separate facility fee (hospital or surgery center) 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 facilities (hospitals and surgery centers). 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 as well as facility fees at Midlands Orthopaedics Surgery Center (MOSC). If you are having surgery at the hospital instead, 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 in the following categories:

  • Office visits
  • X-rays in office
  • Injections in the office
  • Surgical fees
  • Braces and Equipment
  • MRI

I am currently only contracted with Blue Cross to treat patients covered by their various 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. You pay your copays and deductibles as required by your insurance contract. Most out of state Blue Cross plans have reciprocal arrangements with SC Blue Cross and I am therefore also "in network" for most OOS Blue Cross. As demands for my services increase, I may also end my contract with Blue Cross.  Generally, specialists with the least demand for their services feel compelled to sign contracts with more insurers at higher discounts.

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 for Fees and Insurance.

Phone Consultation

If you are interested in determining if you are a candidate for surgery, please mail your completed new patient forms to the office and include a digital x-ray. Dr. Gross will call you back to discuss your options.

Download New Patient Forms

Located in South Carolina

Irmo Office

1013 Lake Murray Blvd.
Irmo, SC 29063

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Columbia Office

1910 Blanding St.
Columbia, SC 29201

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