Insurance can be confusing. Orthopedic Institute helps patients navigate this process with accurate information and a commitment to transparency. Located in Tea and serving surrounding communities, Orthopedic Institute prioritizes quality care while ensuring patients understand their insurance coverage, payment responsibilities, and documentation needs.
Verifying Coverage with Your Insurance Provider
Every insurance plan is different. Some plans include Orthopedic Institute as in-network. Others do not. The only way to confirm network status is by calling your insurance provider directly. Ask about coverage for both the clinic and the hospital if surgery is involved. Verify whether referrals or prior authorizations are needed. These requirements depend on your plan and may change over time.
Patients may also call Orthopedic Institute at 605.331.5890 (Option #2) for help verifying plan participation. However, your insurance company provides the final determination on coverage, referral requirements, and prior authorization policies.
Coverage Through Sanford and Avera Health Plans
Orthopedic Institute provides care for patients covered by Sanford and Avera Health Plans. These two major carriers offer multiple plan types, each with different benefits and requirements. Patients must contact their plan’s member services to verify in-network status. Before scheduling, ask about referral or authorization requirements. Every detail confirmed in advance helps reduce delays or billing issues.
Bring Your Insurance Card and Understand Co-Payments
A valid insurance card is required at every visit to ensure accurate claim submission and efficient communication with our billing team. Co-payments are due at check-in. Please note that claims cannot be processed without proper documentation.
Your insurance card contains essential billing data. Without it, Orthopedic Institute cannot file a claim. The card must be presented at every visit, no exceptions. Co-payments must be paid before the appointment begins. These amounts are set by your insurer and required for care to proceed.
After your visit, the billing team submits a claim to your insurance company. Once processed, your provider sends an Explanation of Benefits (EOB) explaining covered services and patient responsibility. Orthopedic Institute then issues a billing statement if any balance remains. Most patients receive this statement within 30 to 45 days after their appointment.
Understanding Out-of-Pocket Costs and Medical Supplies
Many patients receive a bill even after insurance pays a portion of the claim. This typically reflects out-of-pocket expenses such as co-pays, deductibles, co-insurance, or services not covered by your plan. Orthopedic Institute does not control these costs. They are defined by your insurance provider.
Additional charges may also apply for certain medical supplies. Items such as braces, boots, or other durable medical equipment are billed separately. These charges depend on your plan and may require approval or carry specific limitations.
Referrals and Prior Authorization Requirements
Insurance plans vary on referrals and prior authorizations. Some allow direct scheduling. Others require a referral from a primary care provider. For procedures such as injections, imaging, or surgery, prior authorization is often needed. Orthopedic Institute initiates the request. However, it remains the patient’s responsibility to confirm that authorization has been obtained before the procedure occurs.
Failure to secure required authorizations may result in denied claims. Always confirm your plan’s rules before treatment begins. Early preparation avoids delays and protects against unexpected billing issues.
Accepted Insurance Plans
Orthopedic Institute partners with many major insurance carriers. Commonly accepted plans include:
- Avera Health Plans
- Sanford Health Plans
- Aetna
- Blue Cross Blue Shield (BCBS)
- Cigna
- UnitedHealthcare
- HealthPartners
Participation may vary by plan and product type. Always contact your insurer or Orthopedic Institute to confirm network eligibility. Hospital-based services may have different coverage terms than clinic-based care.
Patients Without Insurance
Uninsured or self-pay patients are welcome at Orthopedic Institute. Payment is due at the time of service. Cost estimates and financial policies are available upon request. Patients can ask about self-pay rates, required deposits, and available payment methods prior to scheduling. Preparing ahead ensures clarity and reduces stress on the day of your appointment.
Requesting Medical Records
Patients who need access to their records should call 605.331.5890 and ask for the medical records department. Requests are handled in compliance with privacy laws and completed in a timely manner. Records may be used for personal reference, insurance needs, or coordination with other providers.
Your Path to Confident, Covered Care
Orthopedic Institute continues to support patients throughout Tea, Sioux Falls, and surrounding areas. The team focuses on accurate billing, patient education, and exceptional orthopedic outcomes. Understanding your plan, preparing documents, and asking the right questions before your visit helps create a smoother experience.
Start by contacting your insurance provider. Confirm that Orthopedic Institute is in-network. Understand your plan’s referral and authorization requirements. Bring your insurance card and prepare for co-payments. If you have concerns, call 605.331.5890 for help.
Every step taken in advance brings clarity and confidence to your care. Orthopedic Institute delivers more than treatment—it provides guidance, accountability, and peace of mind with every visit.