Contact your insurance company. Deductible, coinsurance, and copayment amounts are written into your insurance policy. If you don’t know the specifics of your individual plan, your insurance company will be able to provide you with that information.
At Orthopedic Associates of Lancaster, our policy is to collect your copay at the time of service. Please come prepared to pay your copay at your visit. (In the case of copays on X-rays, physical therapy, etc., most insurance cards do not document this copay; you may receive a bill for this amount.)
Please click here to open an Adobe PDF guide to understanding your statement.
The details of your insurance coverage are outlined in your policy. Covered services are often outlined according to their service category, i.e. surgical benefits, physical medicine (therapy), office visits, and DME (durable medical equipment: braces, slings, crutches, etc.).
Patients are typically concerned with their out-of-pocket expenses regarding these various categories. Deductibles, co-insurance, and co-payments are the three factors that may contribute to your potential out-of-pocket expenses. Some insurance plans, however, do not cover a given category at all. If you received a service that was not covered by your insurance plan, you would be financially responsible for the entire charge.
To highlight this point, please follow along with these two examples.
Scenario #1: A patient, Jane Doe, presents to OAL with a commercial insurance plan. She is evaluated by one of our specialists for her injury. The physician decides to treat her fracture by placing her in a walking boot to stabilize her lower leg and allow the bone to heal properly. Jane’s plan does have DME coverage, but carries a $500 deductible. OAL charges $500 for the boot Jane receives. Her insurance is billed, and due to their contract with OAL and the fact that Jane’s plan has DME coverage, her commercial carrier discounts OAL’s charge and “allows” $250 for the boot. Jane has not met any of her deductible this plan year, and she is therefore personally responsible for the $250.
Scenario #2: A patient, Jane Doe, presents to OAL with a commercial insurance plan. She is evaluated by one of our specialists for her injury. The physician decides to treat her fracture by placing her in a walking boot to stabilize her lower leg and allow the bone to heal properly. Unfortunately, Jane’s plan does not cover DME. OAL charges $500 for the boot, and since DME is not covered by Jane’s plan, she is therefore personally responsible for the entire $500.
It is important to differentiate between two terms frequently used when discussing insurance policies; covered services and out-of-pocket expenses. A service (physical therapy, DME, MRI), as described in scenario #1, could be covered by an insurance plan, but based on its provisions, still carry out-of-pocket expenses for the patient. As a patient, you should understand the terms of your policy – what is covered and what you may be personally responsible for. Our billing team is more than willing to assist you in the process of understanding your coverage. Simply call us at (717) 299-1928 or send us an email.
Depending on the anticipated office follow-up visits for your fracture, you may be charged a “global” fracture care charge rather than individual office visit charges.
“Global” is the period of time (usually 90 days) following a surgical procedure for fracture care. During this time, ALL of your follow-up visits for this condition are included in the initial charge. However, X-rays and some supply costs (for casts/splints) are not included in the global fee. You also may incur additional charges if the doctor evaluates other conditions during this time.
Each year, the American Medical Association (AMA) publishes a book entitled “Current Procedural Terminology (CPT)”. This book provides 5 digit codes used by practically all doctors to describe medical procedures. These codes must be used when submitting charges to insurance companies. Every CPT code in the “Musculoskeletal System/Surgery” section of this book is classified as “surgery”. This is the section from which the codes for care of your fracture must be selected. Fracture care is described either as closed treatment (no surgery need) or open treatment (surgical treatment required). This is why you may see the word “surgery” on your Explanation of Benefits (EOB) from your insurance company.
All of your follow-up office visits for this condition are included in the initial charge for a specific period of time, usually 90 days. X-rays and some supply costs (for casting and splinting) are NOT included in the global fee and will be billed to your insurance company.
In most instances, initial treatment of a fracture involves splinting with later application of a cast (if needed) once the swelling subsides. It is fortunate that you do not require surgery. The treatment plan is based on the doctor’s medical training and orthopedic expertise to identify the fracture and assess its severity. Anyone can look at an x-ray, but it takes a trained professional to interpret the image-to know whether it will require reduction (setting the bone) or surgery. The value of this medical training and expertise is not in the type of dressing, cast or splint applied but in the ability of the doctor to correctly assess the situation and render a medical judgment.
Insurance coverage and payments can vary greatly from plan to plan. If you have any questions about your coverage, please contact your insurance company directly. In some cases, the co-payment amount required by your policy for an initial fracture care appointment may be higher than that for a regular office visit. It is advisable to be fully informed and understand the details of your specific plan. Our staff will be happy to assist you with any questions you may still have regarding your bill.
We thank you for choosing Orthopedic Associates of Lancaster for your care.
Although they both reside in the same location, 170 North Pointe Blvd, Orthopedic Associates of Lancaster (OAL) and North Pointe Surgery Center (NPSC) are two separate legal entities. OAL is a full-service orthopedic practice offering comprehensive care, and NPSC is an ambulatory surgical center where outpatient procedures are performed by OAL doctors each day. The billing of their services is also separate.
When you have surgery, you can generally expect three bills for the services you receive: one for the physician (professional fee), one for the facility, and one for the anesthesiologist. If your surgery is performed by an OAL physician at our North Pointe Surgery Center, the professional fee and its associated bill will come from OAL and the facility fee will be billed from North Pointe Surgery Center. Orthopedic Associates of Lancaster’s billing office can be reached 7:30 a.m. – 5 p.m. weekdays at (717) 299-1928 or you can contact us online. North Pointe Surgery Center can be reached 8 a.m. – 4:30 p.m. weekdays at (717) 735-6650.
If you choose to pay your bill through our secure service provider, Instamed, you do not need to register or set up an account. Simply fill out your patient and payment information and follow the three steps shown.