Fees and Insurance
(Updated 10/25/2011)
II. Quick Reference for Insurance Coverage
If I do not have a contract with your insurance plan, I am considered “out-of- network”. If your insurance company does not appear on the following list, I am NOT in your network and this section applies to you.
“In Network” plans:
- Aetna PPO
- Blue Choice
- Blue Cross Blue Shield Federal Employee Plan
- Blue Cross Blue Shield SC *
- Blue Cross Blue Shield State Health Plan (SC)
- United Healthcare
*Most standard Blue Cross/ Blue Shield plans from other states have a reciprocal agreement with Blue Cross of SC and are therefore also “in network”. We can tell you if this applies to your Blues plan.
If your insurance plan does not appear in the above list, I am “out-of-network” with your insurance company, and the following information does apply to you.
I will bill your insurance company directly after services are provided.
Payment for Surgical Services:
- I will request that you pay $4000 in advance (for primary hip or knee surgery)
- I will bill your insurance company $5000.
- Any amount the insurance carrier pays me up to $4000 will be refunded to you.
- Your maximum payment to me will be $4000.
Payment for Office Services:
- I will ask you to pay 50% at the time of service.
- I will bill your insurance the full amount.
- We will reconcile the bill 3 months after services are provided.
- Any amount not paid by insurance within 3 months of the service will be your responsibility to pay.
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