Insurance

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. Our scheduling representatives can be reached at 813-978-9797.

MET YOUR DEDUCTIBLE?

Depending on your health insurance plan, your deductible is the amount you pay out-of-pocket
each year before insurance begins to cover any medical costs. Deductibles don’t always apply to
all services. Most plans cover routine doctor visits, prescription drugs, and preventive care
before you’ve met your deductible.

After you’ve “met your deductible,” you’re only responsible for a percentage of the cost of
service (called coinsurance), a copay or a flat fee, depending on your policy. With coinsurance,
you and your health insurer share the responsibility of paying for your medical expenses.

Here’s an example.

  • Let’s say you have a plan with a $1,500 deductible and an 80/20 coinsurance.
  • 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 other 20%.

If you’ve met your deductible for the year, you’ll only need to pay for your percentage of a
procedure. Using the same insurance situation above, here’s what a $2,500 procedure would
look like, with and without meeting your deductible.

NOT HAVING MET YOUR DEDUCTIBLE (assuming it’s January 1, and you haven’t spent
anything toward your deductible)
$2,500 Procedure
-$1,500 You pay in deductible
$1,000 Balance

$800 Coinsurance pays (their 80% of the $1,000)
$200 You pay in coinsurance (your 20% of the $1,000)

$1,500 You pay in deductible
$ 200 You pay in coinsurance (your 20% of the $1,000)
$1,700 The total you’ll pay

MET YOUR DEDUCTIBLE
$2,500 Procedure
-$ 0 You pay in deductible
$2,500 Balance

$2,000 Coinsurance pays (their 80% of the $2,500)
$500 You pay in coinsurance (your 20% of the $2,500)

$0 You pay in deductible
$500 You pay in coinsurance (your 20% of the $2,500)
$500 The total you’ll pay

You can see that the amount of money is a lot lower once you’ve met your deductible. That’s
why many people schedule procedures (especially larger ones) toward the end of the year
when they reach their deductible.

Your policy may also have an out-of-pocket maximum, meaning that once you hit 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.

FSA ACCOUNTS (FLEXIBLE SPENDING ARRANGEMENT)

Many people take advantage of FSA accounts offered by their employer. FSAs allow people with
health insurance to set aside money for health care costs referred to as “qualified expenses,”
including deductibles, copayments and coinsurance, and monthly prescription costs. You
typically get a debit card for your account to pay for qualifying expenses throughout the year.

Sometimes employers contribute funds to these accounts. FSAs are similar in many ways to
another type of account – the HSA (health savings account), but very different in how they
handle unused balances – the amount you have in the account as you approach the end of the
year.

With some exceptions, FSAs have a “use it or lose it,” policy when it comes to any unused
balance. You can’t roll over any remaining funds to the next year (unlike an HSA, which does
allow roll over).

If you have an FSA, make sure to check your balance as you approach the end of the year. If you
need a procedure, it may make sense to use your balance rather than lose it.

If you have an HSA (Health Savings Account), unused balances roll over into the next year.

New Medicare Identification Cards

Medicare will mail new Medicare cards between April 2018- April 2019. 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.

Insurance

Please ensure that your mailing address is up to date with Medicare to ensure that you receive your new card. You can visit ssa.gov/myaccount or call 1-800-772-1213 (TTY: 1-800-325-0778) to correct your mailing address. Visit Medicare.gov 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, we request that you have your current insurance ID number and group number available. When visiting our office, please bring a copy of your insurance card to 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 your insurance prefers.

Below are some useful tips from our specialists in order to educate yourself about potential changes:

  1. Notify our scheduling department at 813-978-9797 as soon as your coverage changes.
  2. 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. For example, you previously may have had unavailable coverage for specific treatments, and now they are covered. Or you might discover that your employer decreased certain coverage. It is so critical to contact your provider and review your plan at the start of a new plan year.
  3. Be proactive and ask the right questions.
  4. 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 primary care physician’s office directly prior to your appointment.
  5. Make time allowances for obtaining an 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 get referrals and authorizations.

At times, 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 the necessary documentation?
  • How much time will the insurance company need in order to process and then provide the authorization?

If you have more questions, please call our office at 813-978-9797