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. Know the specifics of your individual plan.

What is a deductible?

A deductible is a set amount for which a patient is responsible in the course of a year according to his/her contract with the insurance company. For example, if a patient has a $500 deductible, he/she must pay $500 out-of-pocket on services for which the deductible applies before the insurance will make payment. A deductible amount generally applies for one year. Once the year is complete, the deductible must be met over again.

What is coinsurance?

Coinsurance is a percentage of each charge for which a patient is responsible. This amount is determined by the patient’s policy and is non-negotiable. If a patient has 20% coinsurance, for example, he/she is responsible for 20% of each specific charge. Therefore, on a charge of $1,000 the patient would be responsible for $200.

What is a copayment (copay)?

A co-payment is a set amount that a patient is responsible for at each visit. A patient with
a $15 copay will be responsible to pay $15 at each visit. It is important to be familiar with your individual plan. Some plans require a copay for office visits only while others require a copay for office visits as well as X-rays, physical therapy, etc.

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

Yes. OAL’s 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 schedule an appointment?

To schedule an initial appointment with a doctor at Orthopedic Associates of Lancaster, call our schedulers at 717.299.4871. They will take your insurance information and get you scheduled for your visit. Follow-up visits are then scheduled by our exit staff when you leave at the end of your appointment.

Do I need a referral?

Everyone’s insurance plan is different. It is essential that you are familiar with the requirements of your particular plan. If you choose to come to our office and we do not participate with your insurance company, it is your responsibility to contact your primary care physician (PCP) before the visit to obtain an out-of-network referral. It is important to remember, however, that even if we participate with your insurance you may need a referral. Some plans allow you to come to a specialist with or without a referral with the understanding that if you come without a referral you may be responsible for a larger out-of-pocket amount. Ultimately, it is the patient’s responsibility to know whether or not a referral is required.

What if my doctor refers me to a different orthopedist?

As a patient, you may decide which doctor(s) you would like to provide your treatment.
If your primary care physician refers you elsewhere, you may ask them to write a referral to our office. You will want to double check, though, to make sure that our office participates with your insurance company.

How do I get an out-of-network referral?

To obtain an out-of-network referral you need to contact your primary care physician (PCP). Ask them to write an out-of-network referral to our office. Be specific. Tell them the date of your appointment and what you are being treated for. Present your referral at our front desk when you arrive for your appointment.

What if my treatment is not approved by my insurance company?

Many types of treatment require preauthorization, for example, MRI, physical therapy, injections, etc. If your insurance company denies any of these services, you can appeal the decision by contacting your insurance company’s customer service department and asking
for appeals.

How do I know if your office participates with my insurance?

Begin by checking our insurance participation list. If your insurance is not listed and/or you
are still unsure, call your insurance company and give them our tax identification number:
23-187-9220. They can use this number to verify whether or not we are a participating provider.

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.

Do you charge me if I request that your practice complete a form not required by my insurer?

In most cases, yes, just as other medical practices do. Forms take skilled staff time to complete accurately. When a form is not required by your health insurer, we typically charge a prepaid fee of $15.

For detailed information about our forms completion policy, click here.