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Insurance & Payment Tips

Thank you for choosing Golden State Orthopedics & Spine (Golden State Ortho or ‘GSOS’) 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 stress-free as possible. The following information will help you understand our financial policy and aid you in planning for payment.

HMO

GSOS is contracted with various HMO groups. 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 unfortunately not be able to bill your workers’ compensation carrier after treatment has begun. For more information please see our Worker Compensation page.

MOTOR VEHICLE ACCIDENT (MVA) & PERSONAL INJURY

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 40 percent discount off our standard prices.

MEDICARE

GSOS 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 for differences between the GSOS 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

GSOS is “In Network” with various major insurance plans. 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.

NOTE: GSOS ACCEPTED INSURANCES ARE CURRENTLY BEING UPDATED. PLEASE CHECK COVERAGE YOURSELF DIRECTLY WITH YOUR INSURANCE CARRIER. THANK YOU

OUT-OF NETWORK PLANS

Patients may have higher out-of-pocket expenses with the out-of-network insurance plans.

NOTE: GSOS OUT-OF-NETWORK PLANS ARE CURRENTLY BEING UPDATED. PLEASE CHECK COVERAGE YOURSELF DIRECTLY WITH YOUR INSURANCE CARRIER. THANK YOU

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 & GSOS) that were involved in your treatment.

STATEMENTS

Account statements are 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.

PAYMENT

Effective June 1st, 2022 Golden State Orthopedics & Spine will no longer be accepting cash. We will continue to accept all major credit cards and checks. We appreciate your understanding.

OVERDUE & 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.