Payment & Insurance Tips

Payment & Insurance Tips

Thank you for choosing Muir Orthopaedic Specialists (MOS) for your care and treatment. Although billing and payment is not always a comfortable topic, our financial policy and billing practices are part of your overall experience with our practice and we want to make it as seamless as possible. The following information will help you understand our financial policy and aid you in planning for payment.

HMO

MOS is contracted with Affinity Medical Group, John Muir Physician Network, Brown and Toland Medical Group, Hill Physician Medical Group & CCHP. Please make sure that you have a valid referral or authorization prior to being seen. Please note that in certain situations re-authorization may be required.

Workers’ Compensation

In order for us to bill for a work-related injury, we must have an authorization from your workers’ compensation carrier prior to receiving treatment. Should a work-related injury be identified after treatment has begun, we will not back bill your workers’ compensation carrier. Learn more about our Workers’ Compensation program.

Auto Accident (MVA) & Personal Injury

MOS does not bill auto insurance carriers or third-party insurance carriers. Some personal health insurance carriers will pay for visits related to an MVA or personal injury, please contact your insurance carrier to verify this. If your personal health insurance will not pay for these services, you will be considered a “self-pay.”

Self Pay

Patients who do not have active health insurance coverage at the time of service are considered “self-pay.” When you check in at our Front Desk you will be asked to provide a $150 deposit (cash, check, credit card). Please keep in mind that this is only a deposit. Based on the complexity of your visit and any other services that are provided during the visit, such as X-rays, injections, casting or braces, your charges will be greater than $150. Payment in full is expected at the time of service. Your final balance will include a 30 percent discount off our standard prices.

Medicare

MOS and its providers are “participating providers.” This means that we accept Medicare’s allowed amounts for services rendered. Medicare will pay 80 percent of the allowed amount. The patient is responsible for the remaining 20 percent, plus any deductible. We will adjust off the difference between the MOS standard charges and Medicare’s allowed amount.

For patients who have a supplemental or secondary insurance plan, we will submit the claim for the remaining 20 percent once Medicare has paid. Please remember that even though we are participating providers for Medicare, the patient, by federal law, must be held responsible for any portion of the allowed amount that is not paid by Medicare or a secondary insurance plan.

How 2018’s Medicare Changes Affect You

In 2018, Medicare Social Security numbers from Medicare cards in order to keep private information more secure and help protect the identity of individuals on Medicare.

Each person on Medicare should have received a new Medicare number that’s unique to them in the mail. This new card can only be used for Medicare coverage. The new card does not change any coverage or benefits.

Residents of California were in the second wave of mailings and should have received their new cards sometime between April and June of 2018.

PPO

Listed below are some of the major insurance plans that MOS providers are “In-Network” with. It is the patient’s responsibility to be aware of their insurance coverage, policy provisions, and authorizations requirements. It is always a good practice to check with your insurance carrier to verify coverage prior to being seen. This can eliminate any surprise bills after you receive treatment.

In-network insurance plans:

  • Affinity Medical Group (AMG)
  • Aetna HMO (through AMG, BTMG, HPMG or JMPN)
  • Aetna EPO & PPO
  • Anthem Blue Cross (Out of State BX/BS Plans)
  • Beech Street PPO – MULTIPLAN
  • Blue Cross of CA HMO (through AMG, BTMG, HPMG or JMPN)
  • Blue Cross of CA PPO (Anthem)
  • Blue Shield of CA HMO (through AMG, BTMG, HPMG or JMPN)
  • Blue Shield of CA PPO
  • Brown & Toland Medical Group (BTMG)
  • Canopy Health – HPMG, JMPN or Mertiage
  • CHAMPVA
  • Choice Care Network – Humana PPO
  • Cigna HMO (through AMG, BTMG, HPMG or JMPN)
  • Cigna PPO
  • Contra Costa Health Plan (CCHP)
  • Coventry/First Health WORK COMP
  • GEHA (Government Employees Health Association) – Aetna
  • Golden State HMO (Medicare HMO – HPMG Only)
  • Great West Healthcare Now CIGNA
  • HealthNet HMO (through AMG, BTMG, HPMG, JMPN, Canopy – Meritage)
  • HealthNet POS must use HMO portion (through AMG, BTMG, HPMG or JMPN)
  • HealthNet EPO & PPO
  • Hills Physicians Medical Group (HPMG), can be Hill East Bay Alliance (NO PT)
  • Humana PPO
  • Humana HMO (AMG, HPMG or JMPN)
  • John Muir Physician Network (JMPN)
  • Medicare
  • MultiPlan (Beech Street, PHCS) PPO
  • MultiPlan Work Comp
  • Pacific Foundation for Medical Care – PPO ONLY
  • Private Health Care System (PHCS) – MultiPlan
  • TriWest (TriCare Select/Standard)
  • TriWest (TriCare Prime or Prime Remote)
  • United Healthcare PPO (UHC)
  • United Healthcare HMO (through AMG, BTMG, Canopy, HPMG or JMPN)
  • United Healthcare HMO Advantage Plan – JMPN Canopy Health
  • United Healthcare EPO
  • Veterans Administration (VA)
  • Western Health Advantage HMO (Canopy)

Out-of-Network Plans

Patients may have higher out-of-pocket expenses with the following insurance plans:

  • Coventry/First Health PPO
  • Interplan PPO and W/C
  • Stanford Health Care Alliance (Aetna)
  • Sutter Select PPO thru UMR
  • UMR – United Medical Resources

Surgical & MRI Charges

If your deductible has not been completely met or you have a high co-insurance percentage, you will be required to make a deposit prior to your surgery. If this is the case, you will be contacted by an accounting department representative.

Please keep in mind that you could receive a bill from multiple providers (facility, radiology, anesthesia, lab & MOS) that were involved in your treatment.

Account Statements

Statements will be sent out on a monthly basis. You will receive a statement if there is an outstanding balance on your account. Payment is due within thirty (30) days.

Methods of Payment

We accept cash, checks, VISA, MasterCard, Discover, and American Express. You can even pay your bill online, login or enroll today.

Overdue & In-Collection Accounts

Patients with past due accounts (balances 60 days or older) will be asked to make payment in full prior to being seen in the office for anything other than surgical follow-up. Patient accounts that have previously been sent to our collection agency will not be allowed to schedule appointments until their account has been paid in full.

Insurance Terminology

Co-Payment: The fixed dollar amount set by your insurance contract that you are required to pay each time you are seen in the office.

Co-Insurance: The percentage set by your insurance contract that is deducted from the insurance benefits and is required to be paid by you.

Deductible: The annual dollar amount set by your insurance contract that is deducted from insurance benefits and is required to be paid by you.