Please read the following, then click on the link at the bottom of this page to download, print and sign.
This outlines your financial responsibilities for treatments by Central Coast Orthopedic Medical Group.
All patients are ultimately responsible for payment for all services rendered, whether insured or uninsured.
Please bring your insurance card(s) with you to every appointment. If your insurance plan has changed since your last visit, please tell us. If you are unable to provide valid insurance information at the time of your visit, you will be expected to pay in full or reschedule at the time of service.
We participate in most major and regional health plans in our area, as well as Medicare, Medi-Cal and Cen-Cal, and will file claims with your insurance carrier(s). If you have secondary insurance, we will file a claim with them as soon as the primary carrier has paid.
Prior Authorization –vs- Self-Referral: Cen-Cal, Medi-Cal, HMO, EPO and some other insurance plans require prior authorization through your Primary Care Doctor before we can see you. Most other insurance plans allow you to self-refer, but you need to be aware of your own policy’s requirements.
Co-Pay: If your insurance coverage indicates that a co-pay is due for your office visit (see your card), we are required to collect this at the time of service.
Your Portion of the Charges: You will be responsible for your share of charges as defined by your policy plus any charges for treatments that your insurance carrier will not pay for. If we have not received payment from your insurance company within 90 days of the date of service, you will be expected to pay the balance yourself.
If Your Insurance Company Requests Information from You: You must respond to any information requests from your insurance carrier or your claim(s) could be denied and you would be responsible for payment.
We accept Blue Shield’s Covered California non-HMO plans.
In August 2018 we reached agreement with Blue Shield to cover all their non-HMO patients, including their Covered California network patients. If you’re one of their patients, WELCOME!
Uninsured Patients / Out of Network Patients
If you have no insurance, or if we are not in your insurance plan’s network of doctors (e.g., Covered California), we can still treat you, but you will have to pay at time of service.
- Self-Pay patient. You will pay the entire bill, with no involvement by an insurance company. We have a discounted fee structure for this.
- Out of Network. You will pay the entire amount of your treatment on the day of service, then your insurance company will reimburse you directly.
If you are injured at work, you must contact your employer and notify them of the injury before we are allowed to treat you. We can only schedule an appointment for your work injury after we have authorization from your employer’s insurance. We then bill their Worker’s Compensation insurance carrier for your treatment, not yours. Warning: if your employer later concludes that the injury was not work-related, you (or your private insurance) will be responsible for paying the bill.
Surgery: Pre-Pay Your Portion of Costs
If you require surgery, we will estimate your portion of the planned surgery costs. The amount will be determined by your insurance plan terms and how much of your deductible you have already met. You will be required to pay this portion prior to surgery.
If you are unable to pay your portion of an elective procedure prior to surgery, we will refer you to our Patient Financial Counselor to explore your alternatives, which might include postponing your surgery.
Paying Your Bill
After your insurance carrier(s) have paid their portion(s) we will send you a statement for your balance due. Payment in full is expected when you receive your statement.
If you are unable to make payment in full, please talk with our Patient Financial Counselor at (805) 541-4600, extension 179, to discuss options. In some cases, we can set up a monthly payment plan for you.
Methods of Payment
You may pay by cash, check, Visa, MasterCard and Discover cards. You can pay at the reception desk, mail us a check, or make payment by phone at (800) 478-6675. If you are on a monthly payment plan, payments will be automatically billed to your credit / debit card on the date you chose with our patient financial counselor.
If you have not paid your balance or talked with us to set up an acceptable payment plan within 120 days, we will transfer your account to an outside collection agency. In such a case we would ask you to find a different orthopedic surgeon for any future orthopedic problems.
If there is an overpayment on your account once your insurance has settled, we send you a refund check.
Other Facilities and Provider Fees
If you are having surgery, please be aware that your Central Coast Orthopedic Medical Group bill will cover only the Orthopedic Surgeon’s charges. The Hospital / Surgery Center and Anesthesiologist will be sending you separate bills for their portions of your surgery.
More Questions? Talk with the Practice Manager at the office where you receive treatment.
- Click here to DOWNLOAD, PRINT and SIGN our Financial Policy.
Bring a signed copy of this financial policy with you to your next visit.