Insurance Information

At Orthopedic Specialists of SW Florida, we accept most major insurance carriers, and we frequently treat injured employees who are on Workers’ Compensation.

We participate with the following major carriers:

  • Aetna
  • Auto/PIP
  • Blue Cross Blue Shield*
  • Cigna
  • Healthsmart PPO
  • Humana**
  • Medicare
  • Multiplan PPO/PHCS
  • NPPN PPO
  • Staywell
  • Tricare
  • UHC/AARP/Wellmed Medicare Complete
  • United Healthcare
  • Veterans Administration
  • Vocational Rehabilitation
  • Web TPA
  • Workers’ Comp

*We accept all products, except Blue Select and My Blue.

**We do not accept Humana Medicare HMO Gold.

We do not accept Medicaid or Medipass unless the patient was seen in the ER at a time one of our physicians was on call.

If you do not see your plan on this list, we will be happy to verify benefits.

Insurance Authorizations

Office Visits:

Within one to two business days prior to your appointment, an Insurance Verification Specialist will verify your insurance eligibility, co-payment, deductible, and any referral requirements. We make every attempt to obtain authorization prior to your visit, but many insurance plans require an authorization from the patient’s primary care physician or referring provider. Contacting your primary care physician at least two days prior your appointment is highly recommended.

Diagnostic Testing and Physical/Occupational Therapy

Our dedicated Insurance Authorizations team will obtain authorizations for all diagnostic tests and physical/occupational therapy ordered by your OSSWF physician. Please note, chiropractic visits often count toward your allowed number of therapy visits and therefore may limit your coverage for physical therapy. It is very important to let our office know if you are receiving chiropractic care or physical/occupational therapy at another location.

What Will My Insurance Cover?

The answer to this depends on your specific insurance policy, and you will most likely need to contact your provider to discuss the details.

One important factor to keep in mind is whether or not you’ve met your deductible. The deductible is the amount of money you must pay out of pocket before your insurance company starts covering expenses. Once you’ve met your deductible, you may be responsible for a percentage of the costs (coinsurance), a copay, or a flat fee. Sometimes, however, the insurance policy will cover all of the expenses – it all depends on your specific policy.

Example:

  • Your medical expenses are $1,500 and you have a $1,000 deductible with a 90/10 coinsurance
  • You will pay $1,000 before the insurance company covers anything.
  • Your insurance company will pay $450 (90% of the remaining charges)
  • You will pay the remaining $50 (10% of the remaining charges) as per your coinsurance arrangement

The best person to answer your insurance questions is your insurance representative, but our Insurance Verifications Specialists will be happy to assist you in any way we can.

We collect all copays, deductibles, and coinsurance at the time of service. Surgeries charge estimates are collected in advance. Additional charges may be added or credit may be provided to you once the insurance information is processed.

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