Loading
Lancaster County: (717) 299-4871
Lebanon County: (717) 277-7005
Request an Appointment

Online Business Office

At Orthopedic Associates of Lancaster we are proud to introduce our Online Business Office, a unique and convenient resource to assist patients with all insurance, account, and financial questions and concerns. Feel free to email a representative with any account inquiries or coverage questions.

In conjunction with this online tool, you can reach our onsite billing office at (717) 299-1928, Monday through Friday from 7:30 am - 5 pm.

QUICK LINKS:

At OAL, we know that billing and insurance issues can be confusing, particularly when the scope of treatment spans our various services: office visits, physical/occupational therapy, surgery, etc. The mission of our Online Business Office is to help you understand your bill and any balances for which you are responsible. We want to create a place where you can find answers to your questions and contact us online at your convenience.

Prior to receiving services from OAL, we will work with you to help understand what your insurance covers and any out-of-pocket expenses that may be incurred. We strive to keep our patients fully informed so there are no surprises upon receipt of a bill.

We also offer pay-in-full, cash discount, and/or payment plan options for our local Amish population.

Financial Policies

To help eliminate confusion and best serve our patients, please download and read the policies below. We recommend that you read and understand these policies prior to visiting one of our locations.

Frequently Asked Questions

How can I find out if I have a deductible, coinsurance, and/or copayment?

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.

Am I responsible to pay my co-payment at the time of my visit?

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.)

How do I read my statement? I don’t understand what it is saying

Please click here to open an Adobe PDF guide to understanding your statement.

Is my leg brace, walking boot, physical therapy, MRI, and/or surgery covered by my insurance?

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.

What is a “fracture care” charge and why is my insurance processing it through my surgical benefits?

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.

What does the term “global” mean?

“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.

I had a fracture and was placed in a cast-why does my Explanation of Benefits (EOB) sent by my insurance company say that I had surgery?

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.

What does “fracture care” include?

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.

The doctor did not do anything except take x-ray and put me in a splint-why was I charged for fracture care?

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.

Why am I receiving two bills, one from Orthopedic Associates of Lancaster and one from North Pointe Surgery Center?

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.

I went to pay my bill online using OAL’s Instamed service and cannot understand the registration portion

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.

Definitions

Deductible

The deductible refers to the amount of money an insured, or insured's dependent, must pay before any benefits from the health insurance policy can be used. This is usually a yearly amount, so when the policy begins again, usually after a year, the deductible would be in effect again.

Ex: OAL may charge $2,000 for a procedure. OAL's contractual agreement with a given insurance states the insurance will agree to pay (allow) $1,000 for that procedure. If a patient's insurance benefits outline a $1,000 deductible, none of which has been met (paid in the respective benefit year), the patient is responsible for the $1,000 allowed by the insurance company. If a patient's deductible was $500 in the previous scenario, they would be responsible for $500 and the insurance would pay the remaining $500.

Co-insurance

As defined by the insured's benefits, a co-insurance is typically a percentage-based amount that is the responsibility of the insured. Common co-insurance splits are 80% insurance company, 20% patient and 90% insurance company, 10% patient.

Ex: OAL may charge $2,000 for a procedure. OAL's contractual agreement with a given insurance states the insurance will agree to pay (allow) $1,000 for that procedure. If a patient has an 80/20 co-insurance (80% insurance company, 20% insured) and their deductible, if applicable, has been met for the relative benefit period, the insurance company would pay $800 and the patient would be responsible for $200.

Co-payment

A co-payment (copay) is a fixed amount that the insured is required to pay at the time of service. It can be thought of as a per-visit, fixed charge for the medical services rendered. Insurance plans often assign varying copays to different physician care levels. Orthopedic Associates of Lancaster is a Specialty physician's office, and an insured's copay with our physicians will therefore reflect their plan's Specialty co-payment amount.

Health Maintenance Organization (HMO) and Referrals to Specialty Providers

HMOs are a form of health insurance whose plans offer a wide range of healthcare services through a network of providers that agree to supply services to their members.

As a member of an HMO, an insured will be required to choose a primary care physician (PCP) from a list of in-network providers for that plan. Before an HMO participant can see a specialist, they will need to see their PCP and obtain a referral from him or her.

HMO plans will not cover patients who see a specialist prior to obtaining a referral, which often results in the insured being responsible for the entire bill.

Coordination of Benefits

If the insured has two or more sources that would cover payment for certain conditions, such as being under a spouse's insurance plan along with having their own insurance plan, the insurance companies would not pay double benefits. In this case, the health insurance companies would coordinate benefits (through information supplied by the insured) to make sure each plan pays a portion of the service.

More FAQs

Contact Us

Please use the form below to contact an OAL representative with any questions regarding your account or insurance coverage, or to request an up-to-date ledger. Based on the information provided, we will respond to your request with a phone call or email within two business days.

Common questions and requests that require our assistance to answer include:

  • Do you participate with my insurance? (Please provide your insurance information: Name, Date of Birth, Company/Plan, Group #, MemberID, SubscriberID)
  • If I am self-pay or you do not participate with my insurance, do I owe anything at my first visit?
  • Can I receive an updated ledger?
  • Can you explain my insurance and the potential fees I may incur?
  • Please describe my balance (e.g., Is this a deductible balance or coinsurance? Was I not billed a copay at the time of service?)
  • Can I set up a payment plan? What is the minimum I can pay a month?
  • Will I owe a copay? Is payment due at the time of service?

Providing all of the information requested in the form will help us to better assist you. Be sure to check your preferred method of communication (phone or email). If you prefer to be contacted by phone, please include the best time of day for us to reach you.