Billing & insurance
Please see the information below to understand your billing and insurance options.
Insurance information
Florida Orthopaedic Institute participates with most major carriers. Please consult your carrier or contact one of our scheduling representatives prior to your appointment to verify our participation status with your insurance plan.
After you’ve met your deductible, you’re responsible for a percentage of the cost of service (called co-insurance), a co-pay or a flat fee, depending on your policy. With co-insurance, you and your health insurer share the responsibility of paying for your medical expenses.
Here’s an example:
- Plan deductible: $1,500
- Plan co-insurance: Your insurance company covers 80%, and you cover 20%
- If your costs are less than $1,500 throughout the year, you’re responsible for paying 100% of the total costs.
- If you have an injury or illness that requires a lot of medical care, you’ll first pay your $1,500 deductible.
- Your health plan will pay 80% of the remaining costs, leaving you responsible for the remaining 20%.
If you’ve met your deductible for the year, you’ll need to pay for your percentage (20%, in this example) of a procedure.
$2,500 procedure example: $1,500 deductible + 80/20 coinsurance
- Have not met deductible
- Procedure: $2,500
- Deductible: $1,500
- Balance: $1,000
- 80% Co-insurance Coverage: $800
- Your 20% Obligation: $200
- Your Total Payment: $1,700
- Total Insurance Coverage: $800
- Met deductible
- Procedure: $2,500
- Deductible: $0
- Balance: $2,500
- 80% Co-insurance Coverage: $2,000
- Your 20% Obligation: $500
- Your Total Payment: $500
- Total Insurance Coverage: $2,000
Your policy may also have an out-of-pocket maximum, meaning that once you reach a predefined amount within the year, your insurance pays 100%.
The above is an example of how an insurance plan might work. Since everyone’s plan is different, contact your insurance company to help estimate your costs.
Medicare will mail new Medicare cards on a yearly basis. Your card will have a new Medicare number instead of a Social Security number. Please present your new Medicare card to the front desk to update in our system.
Please ensure that your mailing address is up to date with Medicare to ensure that you receive your new card. You can visit Social Security or call (800) 772-1213 (TTY: (800) 325-0778) to correct your mailing address. Visit Medicare for the latest updates.
In order to provide the best and most efficient care for you, we ask that you please provide your current information to our office at all times.
When scheduling an appointment over the phone or visiting our office, we request that you have:
- Your current insurance ID number and group number available.
- A copy of your insurance card at each visit.
Prior to your appointment, we will verify your benefits to ensure we are in-network with your provider. We will also inform you if there is a copay or deductible to meet and which lab facility your insurance prefers.
Is your coverage changing?
- Notify our scheduling department as soon as your coverage changes.
- Occasionally, the same plan does not always mean the same coverage. Even though your plan may appear to be exactly the same as the prior year, your employer may have altered the level of benefits that are available to you. It is important to contact your insurer and review your plan at the start of a new plan year.
- Be proactive and ask the right questions.
- Verify that your referral is current. Most HMO plans require a current referral from your primary care physician before they will cover any visits. Patients can request a new referral by communicating with their primary care physician’s office directly prior to their appointment.
- Make time allowances for obtaining authorization. Reauthorization is necessary at the start of the plan year even if the patient did not change insurance plans. Prior to a patient starting any diagnostic testing or treatment, their plans will require the providers of care to receive referrals and authorizations.
Authorizations can take up to one week to obtain and can postpone treatment start dates for patients. There are two concerns that can influence the length of a possible delay in care:
- Has the patient provided us with the necessary documentation?
- How much time will the insurance company need in order to process and then provide the authorization?
Insurance authorizations
Three to five days prior to your appointment, a representative from Florida Orthopaedic Institute will contact your insurance company to verify eligibility, benefit type, co-payment amount, deductibles and referral requirements. Although we make every effort to obtain authorization for your visit, many insurance companies require the patient to acquire an authorization from their primary care physician prior to the appointment.
Please contact your primary care physician at least three days prior to your visit at Florida Orthopaedic Institute to ensure they have forwarded your authorization. If you arrive for your appointment without authorization, we may be required to reschedule your appointment.
Our clinic authorizations department handles authorizations for all tests requested by the physicians. These include MRI, CT, and EMG, among others. Each insurance company has its own rules regarding diagnostic services. Once your test has been scheduled, a representative from Florida Orthopaedic Institute will contact the insurance company, the primary care physician or the workers’ compensation adjuster to obtain authorization.
Once referred to physical or occupational therapy, our therapy department contacts your insurance company as a courtesy to verify your insurance benefits. They will try to obtain information on insurance coverage, allowed visits and patient responsibility amounts, if any. They will also try to obtain authorization for therapy in cases where authorization is required. It is always recommended that each patient call their insurance company as well, to confirm their benefits and any out of pocket expenses.
Our bracing department provides patients with braces and supports as ordered by our physicians. Patients have a choice of where they receive these items, and for convenience to our patients they are offered at Florida Orthopaedic Institute. Florida Orthopaedic Institute generally charges a deposit amount for each item prescribed. Should the deposit amount exceed the true financial responsibility for the brace/supply any remaining amounts are credited back to any open balances, or refunded back to the patient. Patients will still owe for any amounts not covered by the deposit, including deductibles as noted on the patient explanation of benefits.
Paying a bill
You may pay your bill online using a credit card (Visa, MasterCard, American Express, or Discover), and we will automatically process and post your payment. There is never a charge for making a payment, and your personal and credit card account information is protected by our secure website.
Patient payment plans
For almost 30 years, CareCredit has been providing a valuable financing option for treatments and procedures that typically are not covered by insurance or for times when insurance doesn’t cover the full amount. CareCredit is a healthcare credit card used to pay for deductibles, co-payments and co-insurance. Please contact a Financial Counselor for more details at (813) 978-9700 ext. 6052 or apply online*.
*Link disclaimer:
The CareCredit link is to a website operated by another party. The link provided is for your convenience only. We do not control this website and Florida Orthopaedic Institute is not responsible for the content and performance of this site or for your transactions. Florida Orthopaedic Institute‘s inclusion of this website link does not imply any endorsement of the material on the website or any association with their operators. Florida Orthopaedic Institute does not in any way operate, control or endorse any information, products or services provided by third parties through the Internet.
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