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Insurance Policy

Orthopaedic Specialtists of North Carolina participates with most major insurance companies

For your convenience, Orthopaedic Specialtists of North Carolina participates with most major insurance companies. If your insurance company is not listed below, please feel free to contact our business office for additional information.

At Orthopaedic Specialists of North Carolina, we believe in providing optimal care in a cost wise manner. To serve you more efficiently at the time of your appointment, we require that you bring your insurance card and any co-payment that is due at the time of service. Please let our office staff know if you have recently experienced a change in address, phone number or insurance coverage so that we can better serve you.

It is important to check with your insurance company to ensure OrthoNC is in network with your plan, as well as coverage and benefits before scheduling an appointment.

  • Aetna
  • Blue Cross / Blue Shield
  • CareSource North Carolina (Marketplace Plan)
  • Cigna
  • Coventry/Wellpath
  • Cypress Benefit Administrators
  • Dakota Care
  • Healthscope
  • Humana
  • Keyhealth
  • Liberty Advantage HMO
  • Mail Handlers
  • Medcost
  • Medicare
  • Medicare Advantage Plans-PFFS
    • Advantra Freedom
    • Aetna Medicare Plan
    • Alignment Health-First Carolina-First Medicare Direct HMO (Preferred Plus), Direct Smart HMO
    • America’s First Choice
    • Blue Medicare HMO
    • Blue Medicare PPO-Individual
    • Evercare by UHC
    • Experience Health Medicare HMO (EVEJ-prefix)
    • Gateway Health Plan
    • GEHA (UHC)
    • Golden Rule
    • Humana Gold Choice
    • Humana Medicare Group PPO
    • Secure Horizons
    • United Healthcare Group Medicare Advantage (HMO)
    • United Healthcare Group Medicare (PPO)
    • United Healthcare Choice
    • Wellcare Medicare
  • Medicaid
    • Medicaid Carolina Access
    • NCHC
    • QMB
    • QMB/Low Income Medicare Part B Premium
    • QMB/Medicare Part B Premium
    • Restricted Coverage
  • Medicaid MCO Plans
    • Amerihealth
    • Carolina Complete
    • Healthy Blue of NC
    • United Healthcare Community Plan
    • Wellcare NC Medicaid
  • Meritain Health
  • Multiplan
    • American Workers Insurance Services
    • PHCS
  • Paradigm
  • Security Health Plan
  • Tricare
    • Prime
    • Prime Remote
    • Standard
    • Triwest
  • VA medical Center (Or Administration)
    • Veterans Choice Program – VACAA
  • Vocational Rehab
  • United Healthcare

It is best to check with your insurance company before making an appointment to determine if your visit will be covered.

To facilitate your visit at Orthopaedic Specialists of North Carolina, we recommend you reviewing and completing our Patient Forms prior to your visit.


Your Rights and Protections Against Surprise Medical Bills

When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.

What is “balance billing” (sometimes called “surprise billing”)?

When you see a doctor or other health care provider, you may owe certain out-of-costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.

“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.

“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care-like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.

You are protected from balance billing for:

Emergency services

If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.

Certain services at an in-network hospital or ambulatory surgical center

When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.

If you get other services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.

You’re never required to give up your protections from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.

When balance billing isn’t allowed, you also have the following protections:

  • You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-pocket network providers and facilities directly.
  • Your health plan generally must:
    • Cover emergency services without requiring you to get approval for services in advance (prior authorization).
    • Cover emergency services by out-of-network providers.
    • Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
    • Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.

If you believe you’ve been wrongly billed, you may contact the No Surprise Help Desk at 1-800-985-3059.

Visit https://www.cms.gov/nosurprise… for more information about your rights under federal law.

Visit https://www.ncleg.gov/EnactedL… for more information about your rights under N.C. State law.