If you are a new patient or have not been here for a while, we ask that you provide us with some information. This information will allow us to contact you if necessary and to assist us in filing insurance claims. We also ask that you bring along your insurance card and co-payment when you come for your appointment.
Orthopedic Institute accepts a wide range of health plans. We encourage you to check with your insurance to make sure your health plan provides coverage for your care at Orthopedic Institute and the hospital should you need surgical care. Please call our office at 605.331.5890 and choose option #3 to find out if Orthopedic Institute is covered under your insurance plan. Insurance co-pays are due at check-in.
As a patient of Orthopedic Institute, you may have questions regarding your bill. We have listed some common questions and answers for you that will help explain and provide additional information about your bill.
Q. When will I receive my first statement?
Orthopedic Institute will submit a claim on your behalf to your insurance carrier. After your insurance provider processes your claim, Orthopedic Institute will send you a statement outlining any out-of-pocket costs you may have. Your statement will include any deductibles and/or co-insurance amounts you may owe. You will receive a statement approximately 30-45 days after you receive services.
Q. Should I bring my insurance card with me?
Yes, Orthopedic Institute will need the information on your insurance card to correctly file a claim with your insurance company. You will be asked to present your insurance card at each visit. Co-payments are due at the time of service.
Q. Do I need a referral?
The need for a referral differs by insurance plan. Please contact your insurance company directly prior to scheduling an appointment to inquire whether Orthopedic Institute is in-network for your health plan. Obtaining a referral is the responsibility of the patient.
Q. Do I need a prior authorization?
The need for a prior authorization differs by insurance plan and the type of procedure or service being provided. Orthopedic Institute will initiate the prior authorization request from your insurance company for you; however, it is your responsibility to make sure that you have prior authorization before receiving certain health care procedures and/or services.
Q. Why didn’t my insurance company cover my entire bill?
Out-of-pocket expenses are determined by your insurance plan during claim processing. These amounts may include co-payments, deductibles, co-insurance and/or non-covered services per your insurance plan. If you have questions or don’t agree or understand the amounts you owe, please contact your insurance company directly as they determine patient responsibility amounts for any services provided to you based on your insurance plan contract.
Q. When do I become responsible for my bill?
You are responsible for your bill at the time you receive services from Orthopedic Institute. We will work with you and your insurance company to get all eligible benefits processed in a timely manner. We will send you a statement approximately 30 – 45 days after you receive services for any patient responsibility amounts you may owe.
Q. Is there a charge for Medical Supplies given at my visit?
Depending on the type of supply, there may be a charge associated with it. Not all supplies are billable, but many are. There will be charges for durable medical equipment; braces, boots etc.
Q. What is fracture care?
Fracture care includes the treatment of the fracture, the first cast or splint applied and all follow-up visits during the global period (except for any complications). Typically, global periods are 90 days beginning from the first date-of-service for care of the fracture. Fracture care is billed as a “package” or global service meaning there is one charge that includes various components of caring for your fracture. Please note: There are some supplies and/or services that are billable in addition or are not included in fracture care (e.g., X-rays). If you have any questions, please contact our billing department at 605.271.1259.
Q. Is Orthopedic Institute covered under Sanford and Avera Insurance Plans?
Orthopedic Institute will continue to provide the same quality care and services provided to you in the past. Please call our office at 605.331.5890 and choose option #3 if you have additional questions or concerns about your plan.
Sanford Health Plan and starting November, 2019 Avera Health Plan has informed their employees Orthopedic Institute will be considered out-of-network. This applies to SANFORD/AVERA EMPLOYEES, WITH SANFORD/AVERA INSURANCE, AND THEIR FAMILY MEMBERS and not to everyone who has Sanford/Avera Health Plan coverage.
Please read this open letter from our President, David Jones, Jr., MD concerning this choice.
If you are a Sanford/Avera employee or a family member of a Sanford/Avera employee who has Sanford/Avera health insurance and you would like to see an Orthopedic Institute doctor, you should contact your human resources and benefits office to express your desire and ask about what options might be available to you to seek and continue your care at Orthopedic Institute.
We appreciate Sanford and Avera employees and their insured family members for putting their trust in Orthopedic Institute and for choosing us for their orthopedic and musculoskeletal care needs. We will make every effort to work with you to provide you with financing options in order for you to receive exceptional orthopedic care. Please call 605.331.5890 and choose option #3 for more information.