Washington Orthopaedics and Sports Medicine does not participate with private insurance plans (Blue Cross/Shield, Aetna, United Healthcare, Cigna, etc.). This is known as being “out-of-network”. We do accept Medicare and some Worker’s Compensation plans (physician specific, please check with the receptionist or physician’s medical assistant when making your appointment). Often, our non-participation in private insurance is incorrectly simplified as meaning, “WOSM doesn’t take my insurance”. What non-participation actually means is that WOSM does not allow insurance companies to arbitrarily set coverage and payment for our services, and we do not necessarily accept their reimbursement as payment in full. The majority of private insurance plans have out-of-network coverage and will make payment for services rendered by non-participating providers. In fact, those plans typically charge additional premium for this out-of-network coverage (you are paying for this coverage; you should be able to use it). As a courtesy to our patients, WOSM submits all charges and paperwork to private insurance carriers and our billing and collection department spend a great deal of time advocating for and negotiating payment on your behalf. Let’s answer the most common question we hear with respect to this topic: “What does this mean for me if I choose to see a WOSM physician?”
Unless other arrangements have been made, patients are asked to pay for office visits at the time of checkout. We accept cash, check and all major credit cards. Office visits may include x-rays, simple procedures, and durable medical equipment (braces, splints, casts, etc.). Unless instructed otherwise, WOSM will submit all charges to the insurance carrier on the patient’s behalf. Some plans send reimbursement directly to patients, others send the check to WOSM, in which case we will send it to the patient.
Surgical procedures are typically not charged to the patient the day of surgery. It is our custom and practice to submit surgical charges to the insurance carrier following the procedure and allow processing and payment from the carrier before charging any balance. Balance-billing practices vary among physicians and are generally dependent upon the nature of charges, insurance payment, and plan-specific deductible and co-insurance assignments. Please be advised that deductible and co-insurance responsibilities are insurance-assigned patient payments based on plan specifics. Failure to collect deductibles and/or co-insurance assignments is known as “fee-forgiveness” and is unlawful. Other portions of the balance bill are addressed on a case by case basis as a private arrangement between physician and patient. WOSM physicians are dedicated to providing the highest quality of surgical care from pre-operative evaluation through the recovery process and every effort is made to accommodate patient needs. We encourage patients to discuss financial questions and necessary arrangements prior to undergoing treatment. Our billing and collection department is also available to discuss expected charges and coverage pre-operatively, so as to limit post-operative confusion. Don’t hesitate to ask, we’re here to help.
Worker’s Compensation Patients
We require that you have a letter of authorization on file with our office prior to your appointment. If we do not have this letter by the time of your appointment, your appointment may be rescheduled.