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 (JMPN) & 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 20 percent discount off of 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.

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

  • Admar (now under MultiPlan)
  • Aetna HMO and PPO
  • Affinity Medical Group HMO
  • Anthem Blue Cross of CA HMO and PPO
  • BCE Emergis (now under MultiPlan)
  • Beech Street PPO (now under MultiPlan)
  • Benefit Panel Services (now under MultiPlan)
  • Blue Shield of CA HMO and PPO
  • Choice Care Network/Humana PPO
  • CIGNA HMO and PPO
  • Contra Costa Health Plan (CCHP)
  • Great West Healthcare HMO and PPO (now under CIGNA)
  • Health Net HMO and PPO
  • Hill Physicians HMO
  • John Muir Physician Network (JMPN) HMO  (MOS PT & MRI are NOT contracted)
  • JMPN Network Select
  • JMPN Senior
  • Medicare
  • MultiPlan PPO
  • PacifiCare PPO & HMO (now under United Healthcare)
  • Pacific Foundation for Medical Care (PPO product only)
  • ppoNext Preferred Health PPO Network (now under Beech Street)
  • Private Healthcare Systems (PHCS PPO)
  • United Healthcare Military & Veterans (TriCare Standard for Life / Prime) Effective 04/01/2013
  • United Healthcare HMO and PPO
  • Workers’ Compensation except for Dept. of Labor and Out-of-State WC plans

Out-of-Network Plans

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

  • CCN (Termination effective 07/2007)
  • Interplan (Termination effective 07/2007)
  • First Health PPO (Termination effective 11/2007)

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 & American Express.

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.


If you have any questions regarding this policy or your account please contact our Accounting Department at (925) 939‐8585 or send us a secure message.