Insurance Information

Overview

Thank you for choosing Pro Sports Orthopedics, Inc. We believe that good care starts with good communication. We have created this policy to help our patients understand the responsibilities that they have for payment of our fees. If at any time you have questions or problems with our fee or payment process, please do not hesitate to contact our Billing Department by phone at (617) 588-3098 or by email at billing@prosportsortho.com

Co-Payments

Your insurance plan determines your co-pay amount and they require that we collect your designated co-payment at the time of service. Please be prepared to pay the co-payment at each visit. If you are unable to pay your co-payment at the time of your visit, you will be charged a $15.00 administrative fee. Failure to pay co-payments upon check-in may result in non-emergent appointments being rescheduled.

Referrals

If you are a member of an HMO, it is mandatory that you get a referral from your Primary Care Physician to see a specialist, have injections/procedures, and have x-rays. Your insurance company will not pay for the visit without a referral. Please call your primary care physician in advance to ask for a referral. If possible, try to get a referral for multiple visits so you do not have to repeat this process every time you come to the office. If a referral has not been obtained and the claim is denied, you will be responsible for payment in full. If you do not have a referral at the time of your visit, you will be required to put a card on file. If the required referral is still not received, you will then be responsible for payment and the credit on file will be charged.

Insurance

Your health insurance policy is a contract between you and your Health Insurance Company or employer. It is important for you to be an informed consumer, who understands the specifications of your insurance policy (e.g., doctor visit coverage, referral/authorization requirements, radiographs, durable medical equipment, etc). If you are uncertain about your current health insurance policy benefits you should contact your plan to learn the details about your benefits, out-of-pocket fees and coverage limits. Our doctors belong to many insurance plans. Before your appointment, please be sure your doctor is in-network and the services are covered under your plan. If your doctor is out-of-network, you will be billed for the cost of care. As a courtesy to you, we will bill your insurance company directly for medical service rendered. If problems arise regarding coverage issues, we will attempt to work with your insurance company to help resolve them prior to making it your responsibility. However, please be advised that you are ultimately financially responsible for payment of medical services rendered by this office. If we receive payment at a later date, you will be reimbursed. If we contact your insurance carrier regarding benefits or authorization on your behalf, we are not responsible for inaccurate information provided to us by your carrier. The information about your plan that we relay to you is in good faith.

Failure to Pay

We expect that each charge will be paid in full the first time it is presented to you. Once your insurance carrier processes your claim, we will bill you for any remaining patient responsibility deemed by your insurance carrier. For the most up to date balance information, please check your patient portal account regularly. Past due amounts may hinder your ability to have appointments scheduled and could result in possible dismissal from the practice. If you cannot pay in full we request that you contact our Billing Department to arrange an acceptable payment plan. Any balance over 90 days, without prior arrangements, may be sent to our collection agency and will be charged a $25.00 fee. If you have a documented financial hardship, please contact our Billing Department. Please note financial hardship consideration is on a case-by-case basis and written documentation from the patient (e.g., W-2 withholding statements, pay stubs, income tax return) must be received for consideration. In every effort to assist you with meeting your obligations, we offer many payment options. We accept all major credit cards, we offer card on file agreements which can easily be done at check-in, auto-withdrawal payment plans for checking account or credit card, and CareCredit.

Financial Arrangement for Procedures

If your treatment includes a surgery/procedure, we will obtain a prior authorization for the surgery/procedure with your insurance carrier. We will also verify your insurance benefits and obtain your coinsurance and/or deductible. Using this information, we will estimate your out-of-pocket portion of that charges for our services. The estimated amount will be reviewed with you before surgery is scheduled. A pre-payment request will be made at that time. Actual services and your final out-of-pocket cost obligation may vary from the estimates. Financing may be available through CareCredit. For more information, contact our Billing Department.

Workers Compensation

Charges for services incurred as a result of a verified work-related injury will be treated as worker’s compensation, and we will bill the workers’ compensation carrier as a courtesy to you. You must provide us your date of injury, claim number, and case manager’s name and telephone number before making an appointment. If you make an appointment using your private health insurance and inform us at the time of the appointment that it is workers comp, we reserve the right to cancel your appointment until the claim can be verified. If your claim is denied, we will bill your regular medical insurance carrier. When the claim is no longer pending and any portion of your claim is ultimately resolved against you by workers’ compensation and your medical insurance, you will be required to pay all amounts due within thirty days.

Motor Vehicle Accidents

As a courtesy to you, we will bill your auto insurance company directly for medical service rendered. To bill your claim directly, you must provide us all necessary information to confirm coverage for these payments with the auto insurance. We will also collect information about your personal medical insurance in case the auto carrier denies your claim. If we do not contract with your medical health insurance, you will be expected to pay at the time of service. As a courtesy, we will then bill to your auto insurance and reimburse you for any payments we’ve received from the auto carrier. Regardless of whether we submit your claim to auto insurance, as the patient, you are ultimately responsible for payment.

Self-pay and Out-of-Network

If you do not have insurance coverage or if your providers are out-of-network with your insurance plan, you will be expected to pay at the time of service and you must have a credit card on file. Pre-payment may be requested for surgeries, procedures, or ancillary medical services.