Billing

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    INFORMATION / BILLING AND INSURANCE

    Currently we participate with the following major insurance carriers. We also accept many out of state plans with authorization from the plan. If you do not see your insurance listed please call our appointment line for more information at (206) 309-4943.

     

    HOURS AND PAYMENT TYPES

    Business Office Hours: 8:00 a.m. – 5:00 p.m. Business Office Phone: (206) 386–2601

    OPA accepts Visa, MasterCard, American Express and Discover credit cards, personal checks and cash.

    For Services Prior to October 1, 2023

    For Services After October 1, 2023

    Effective 10/01/2023 we are no longer part of Proliance Surgeons and have established new network participation with the following insurance plans.

    Participating Insurance Plans:

    • Aetna
    • Aetna MedAdvantage
    • Ambetter Plan (effective 5/29/2024)
    • Blue Cross Blue Shield
    • Cascade Care Select Public Option (effective 5/29/2024)
    • Cigna
    • First Choice
    • Humana Medicare HMO
    • Humana Medicare PPO
    • Humana Medicare Network PFFS Plans
    • Kaiser Access PPO
    • Kaiser Options Federal
    • Kaiser Summit PPO
    • Labor and Industry WA State**
    • Medicare
    • Medicare MedAdvantage Plans
    • Motor Vehicle Personal Injury Protection**
    • Premera
    • Premera MedAdvantage
    • Regence
    • Regence MedAdvantage
    • Self Insured Worker’s Comp**
    • United HealthCare
    • US Family Health Plan
    • Tricare – coming soon!
    • Optum Care Network – coming soon!

    ** Limited availability with some physicians
    ^ Please call OPA to confirm requirements for specific plans
    PLANS UPDATED REGULARLY

    We are PENDING in-network status with the following:

    • MulitPlan

     

    Don’t see your plan? Send us a message with your insurance plan suggestion @ Contracting@opaortho.com.

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    PATIENT RESPONSIBILITIES

    You can help ensure an efficient experience by assisting with the following:

    Please note that co-payments, co-insurance and deductibles are a contractual agreement between you and your insurance carrier. We cannot change or negotiate these amounts.

    ✓  Providing us with your picture identification, insurance card and Social Security number to enable us to submit your claims timely and accurately

    ✓  Knowing your insurance benefits and limitation

    ✓  Ensuring there is an authorization for our providers to treat you if it is required by your insurance, including obtaining a referral.

    ✓  Providing us with copies of any pertinent medical records, including tests (MRI/CT/Arthrogram) and x-rays

    ✓  Paying your estimated portion of the charges at the time of service

    ✓  Paying any additional amount owed when due

    ✓  Completing required incident/accident forms within 30 days of the date of service

    ✓  Maintaining a current account with Orthopedic Physician Associates at all times

    ✓  Providing us with at least 24 hours advance notice should you need to cancel or reschedule an appointment

    Insured Patients

    We will bill your primary and secondary insurance carrier in a timely manner. If you are disputing payment with your insurance carrier or have a balance over $100.00 with us, you must notify our business office and make payment arrangements.

    Co-Pays/Deductibles/Co-Insurance – Please be prepared to pay for your portion of the charges on the date of service.

    Surgery – If surgery is indicated, a pre-payment of both physician and facility fees is required for all elective, non-emergent procedures prior to the surgery being performed. Your out-of-pocket cost is estimated based on your benefits and our fees. Anesthesia and other providers are separate fees.

    Non-Participating Insurance: If we do not participate in the insurance you have, we will file a claim as a courtesy. An out of network consent form and a $300.00 deposit may be required for all new patients and a $200.00 deposit for all established patients. All unpaid claims will become your responsibility 45 days following filing and will be immediately due and payable.

    Balance Billing Protection Act – Click HERE to read more.

     

    Uninsured Patients

    Office Visits – A $300.00 deposit for new patients and a $200.00 deposit for all established patients, may be required toward services provided. If visit and services are paid in full at the time of service, we offer a 20% discount. Office procedures (e.g., casting, Scopes, office procedures, CTs, allergy shots, injections, tests, x- rays) will be billed separately from the office visit.

    Surgery – For uninsured patients having surgery, we offer a 20% discount when charges are paid before or on the day of service (see exclusions below).

    Exclusions – The discounts referenced above do not apply in cases of cosmetic procedures, motor vehicle accidents, third party insurance claims or in other cases when the patient may be reimbursed in full.

    Private pay patients who receive retroactive Medicaid coverage need to immediately notify our business office.

     

    Motor Vehicle Accidents (MVA) Insured and Third Party Patients

    We do not extend discounts for MVA-insured accidents, third party insurance claims or in other cases when patients may be reimbursed in full. We will bill the MVA insurance carrier one time. The bill becomes your responsibility if not paid by the carrier in 30 days. We regret that we are not in a position to confer with attorneys or defer payment obligations while a case settles. If your personal injury protection benefit on your MVA policy is exhausted, we will bill your private insurance at your request provided we are furnished the necessary information at the date of service.

     

    Workers’ Compensation

    If your visit is work-related, we will need the case number and carrier name prior to your visit in order to bill the workers’ compensation insurance carrier. If your workers’ compensation claim is not yet accepted and you have no other insurance, we require a $300.00 deposit that will be refunded after the claim has been opened.

     

    Other Charges

    No Show – Please provide us with at least 24 hours advance notice if you need to cancel or reschedule an appointment. We may charge a fee for missed appointments.

    * Please provide us with at least 48 hours advance notice if you need to cancel or reschedule an appointment and an interpreter has been scheduled. Otherwise, you may be charged for the interpreter.

    Forms – There may be a charge associated with our completion of some forms. We require payment of the charge before returning the completed form to you. A signed Release of Information may also be necessary. Please allow five business days for us to complete forms.

     

    Payment

    Payment Options – We accept cash, checks, major credit/debit cards and money orders for payment (no post-dated or third party checks). We charge a $40.00 NSF fee for any returned checks.

    Alternative Payment Arrangements – If you are unable to pay your balance when due, please contact our business office to make alternative arrangements. Any patient with a past due amount may be denied additional service until the amount is paid or the patient is complying with an alternative payment arrangement.

    Bankruptcy/Prior Bad Debt – Patients who have previously filed for bankruptcy or never satisfied their payment obligations for prior episodes of care with Orthopedic Physician Associates care centers may be required to pay for their portion of new charges at the time of service.

    Overpayments – Patient overpayments may be transferred to another Orthopedic Physician Associates care center to resolve an outstanding balance.

     

     

    FREE AFTER-HOURS ORTHOPEDIC ASSITANCE

    For acute orthopedic injuries after scheduled clinic and urgent care hours, please utilize the HURT! app, in partnership with OPAOrtho, for fast, free access to orthopedic advice with a response time of less than 4 minutes.  Download here www.poweredbyhurt.com/opaortho