“In -network” vs. “Out-of-network”
I do accept payments on your behalf from any private insurance company. My team 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”. Please review the information below based on my status with your insurance plan.
I am not a participating provider in traditional Medicare or Medicaid; any Medicare Advantage or Medicaid Managed Care plan; Tricare; or workers’ compensation.
In-network Insurance Plans
This option applies to all patients who are covered by insurance plans with which I have a contract. I am “in-network” for these plans. You pay only what is required by your plan. My team will pre-certify your services and calculate your out-of-pocket payment based on your plan’s deductible, co-pay and co-insurance requirements. We do require pre-payment of the patient’s out-of-pocket responsibility.
For any non-government insurance plan, we will pre-certify your surgery, bill the insurance company and accept any payment from them on your behalf. If I do not have a contract with your insurance company, I am “out-of-network” with your plan. Your plan may include “out-of-network” benefits. We will pre-certify the services and submit a claim to your plan. You will be responsible for any balance left unpaid by your insurance plan. I require payment-in-full per the rates below prior to the date of surgery. We will refund you any amount paid that exceeds my fee after your insurance plan processes the claim.
Direct Pay Bundled Rates
These bundled rates apply to patients who wish to pay directly for their care apart from any insurance plan. The rate includes fees for the surgeon, surgeon’s assistant, implant, facility fee (ASC or hospital) and anesthesiologist. Patients covered by government-sponsored insurance plans are not eligible for direct pay bundles, nor are patients intending to seek reimbursement from a third party that requires an itemized bill.
|DEXA Bone Scan||$170.00|
Professional Component of Surgical Procedures
|Total Hip Resurfacing/Replacement||$5000.00|
|Total/Partial Knee Replacement||$5000.00|
|Revision or Complex Surgery||$7000.00|
|Hickman Catheter Removal||$1000.00|
Government-sponsored Insurance Plans
I do not participate with traditional Medicare or Medicaid; any Medicare Advantage or Medicaid Managed Care plan; Tricare or CHAMPVA. Patients covered by these plans are responsible for my bill and cannot submit it to those insurance plans or to most Medicare supplemental policies.
Patients covered by government plans are allowed to go outside of the government plan and pay me directly for both office-based as well as surgical services at the rates published above. Surgery will be performed at the hospital where the government plan as well as the supplemental plans will cover hospital facility fees, implant costs and anesthesia fees. Your only costs for the operation will be my surgical fee as well as any copays or deductibles for hospital/anesthesia services required by your government health plan and/or supplemental plan.
Total Joint Replacement Surgery Bundles (ASC or Hospital setting)
Total Joint Replacement all-inclusive bundles include fees for the surgeon, surgeon's assistant, anesthesiologist, ASC or Providence Northeast hospital facility, implants, one night's hotel stay if needed following ASC discharge, 2 home/hotel nursing visits post ASC-discharge, post-operative medications delivered to ASC patients by a local pharmacy; and 90 days of routine post-operative care to include x-rays
|Total Hip Resurfacing/Replacement||$17,625.00|
|Total Knee Replacement||$27,625.00|
Visit our practice’s website to view a comprehensive price list of all office-based services and surgery bundles: https://midorthoneuro.com/pricing.php. Services may also be purchased via the website.
Complications may require repeat surgery, which will be billed separately. Revision surgery is more prone to complications. Treatment for an infection will often require two or more difficult and/or complex procedures. Each additional procedure will be billed separately.