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 spends 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?”
Effective June 20, 2016, WOSM will no longer be submitting office visits to insurance companies on the patient’s’ behalf. We will provide our patients with all the necessary paperwork and a user-friendly coded cover sheet along with instructions for submission. By empowering our patients to interact directly with their insurance carrier, there will be less confusion regarding service coverage and reimbursements will go directly to the patient rather than to WOSM (necessitating a refund to the patient with its incipient delays and confusion). We will continue to submit surgery bills on the patient’s behalf and our billing and collection department is always available for questions or problems. We appreciate your understanding as we are forced to adjust our practice to the ever changing health insurance environment. We apologize for any inconvenience this may cause.
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.