Billing & Insurance FAQs

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ABOUT FRACTURE AND SURGERY CHARGES

CPT Codes

Physicians bill using CPT codes. Physicians are REQUIRED to bill according to the CPT guidelines divided into categories:

• Evaluation and Management which covers office, ER or inpatient exams, histories, review of imaging and outside notes.

• GLOBAL Codes which include treatment of fractures, surgery, injections and other office procedures. This is a bundle package good for 10-90 days of visits. Follow up visits are free within this time. Fractures and Surgeries are global CPT codes. THESE CODES GO TO YOUR DEDUCTIBLE. Included in this package is: treatment of fracture or surgery, 90 days of office follow up visits and the first application of splint or cast.

INSURANCE COMPANIES LIST ALL GLOBAL CODES AS “SURGERY” EVEN IF THE CODE IS FOR A NON-DISPLACED FRACTURE IN THE OFFICE SETTING, AND NOTHING CLOSE TO SURGERY OCCURS.

NOT INCLUDED IN THE GLOBAL PACKAGE:

• Subsequent cast changes – slings – splints – braces- cast supplies

• X-rays

• Treatment not related to the original fracture or surgery

The contracted fee is the “Allowable fee” that you and your insurance company are responsible for.

We hope this helps you understand your EOB (Explanation of Benefits) from your insurance company and our bill based on the EOB from your insurance company.

If you have questions, call your insurance company, and/or our billing company at (520) 529-5526.            We outsource our billing.

Deductible

The deductible is the amount you pay before insurance pays. Deductibles restart January 1st. Some plans pay doctor visits without meeting the deductible first.

Co-insurance

One common co-insurance split is 80/20. The insurance company will pay 80%, and you pay 20%. After the deductible is met, you are responsible for 20% of the bill.

Co-payments

The co-payment is amount due at time of service. We charge the amount our eligibility software shows us. It may be wrong, in which case we will bill you the difference or refund you.

CONTRACTED INSURANCE COMPANIES

Effective January 1st, 2012 our office requires courtesy referrals for ALL insurances policies.

COURTESY REFERRALS APPRECIATED FOR ALL PATIENTS

  • ACPN ( America’s Choice Provider Network)

  • AETNA

  • Arizona Complete Healthcare (AHCCCS)

  • ARIZONA FOUNDATION (See Third Party Payors below)

  • BANNER HEALTH (In-Network)

  • Banner UNIVERSITY FAMILY CARE ( AHCCCS) (Requires referral from PCP)

  • BLUE CROSS BLUE SHIELDwithCERTAIN GROUP NUMBERS (See Third Party Payors on page 2)

  • CARE 1stHealth Plan of Arizona(AHCCCS)

  • CIGNA (HMO plans require referral from PCP) (See Third Party Payors on page 2)

  • C.M.D.P. (Requires Notice to Provider for visit)

  • FIRST HEALTH/COVENTRY/CNN

  • FORTIFIED PROVIDER NETWORK ( soon)

  • GEHA

  • GOLDEN RULE

  • GREATWEST

  • Steward/Health Choice ( AHCCCS) (requires referral from PCP)

  • HEALTH NET (HMO plans require referral from PCP)

  • HUMANA (HMO plans require referral from PCP)

  • Indian Health Services with AHCCCS (Requires dated referral from IHS)

  • Liberty Healthshare

  • MARKETPLACE PLANS (Healthnet AMBETTER)

  • Magellan Complete Care ( Soon)

  • Medi-Share (we accept, but are considered “out of network”)

  • TRICARE (Prime plan requires prior authorization from PCM)

  • UNITED HEALTH CARE – all plans including Community Care (AHCCCS)

  • All Savers through UHC Choice Plus

  • UNITED MEDICAL RESOURCES (UMR) 

  • UNIVERSITY PHYSICIANS HEALTHCARE

  • Banner UNIVERSITY FAMILY CARE ( AHCCCS) (Requires referral from PCP)

    We do accept “out of network” authorizations for private companies we are not contracted with. Please call our office to obtain CPT codes patient will need for you to obtain the auth. Also, we accept self-pay patients. All non-contracted patients will be required to pay in full at time of appointment, and we will courtesy bill for them and refund the deposit.

ARIZONA FOUNDATION Third Party Payors including:

  • ACS / The New England

  • Administrative Service Consultant

  • Advanced Benefit Solutions

  • Allied Benefit Systems

  • Altpros, Inc.

  • Ameriben Solutions / IEC Group

  • American Community Mutual Insurance Co.

  • American National Insurance

  • Assurant Health

  • Avidity

  • Auxiant (formerly Professional Claim Administrators)

  • Benefit Administrative Systems

  • Benefit Planners, Inc.

  • Benefit Systems & Services, Inc.

  • Best Life Assurance Company

  • Brokerage Concepts and/or Brokerage Services

  • Business Administrators & Consultants

  • Canadian Medical Network / Care Mgmt Network

  • CBCA Administrators

  • CDS Administrators

  • Central Reserve Life / Ceres

  • Claims & Benefits, Inc (Refer to Noridian Benefit Plan Administrators)

  • CNIC Health Solutions

  • Continental General Ins / CERES

  • Coresource-Minnesota (previously Core Star)

  • Corp Benefit Svcs of America / Meritain Health

  • Coventry Health Care (previously Mutual of Omaha)

  • Aberdeen Health Care Service Center

  • Charlotte Health Care Service Center

  • Woodward Healthcare Service Center

  • Cypress Benefit Administrators

  • Delta Health Systems

  • ECOM PPO Advisors, Inc

  • Edward C. Levy (CoreSource)

  • Employee Benefit Management Services

  • Epoch Group, The

  • Erin Group Administrators

  • First Administrators / Ecom PPO

  • FMH Benefit Services, Inc.

  • Fox-Everett

  • Freedom Life Insurance Company of America

  • Fringe Benefit Services

  • GEHA

  • Gilsbar, Inc.

  • Global Excel Management, Inc.

  • GMS, Inc.

  • Group Resources Incorporated

  • UMR (formerly Harrington Benefits / Fiserv)

  • HCH Administration

  • HDM Benefit Solutions

  • Healthcare Group / Avidity

  • Healthcomp Administrators

  • Healthfirst TPA / Ecom PPO

  • Health Network America

  • Health Plan Services / ACS the New England

  • Healthscope Benefits, Inc.

  • Hygeia Travel Health

  • Imerica / Healthtrans

  • Insurers Administrative Corp.

  • International Funding, Ltd.

  • John Alden (Fortis – refer to Assurant Health)

  • JSA P5 Utah

  • Managed Benefit Administrators & Insurance

  • Managed Care Administrators

  • Medical Benefits Administrators, DBA MedBen

  • Mayo Clinic Health Solutions, DBA MMSI

  • Mountain States Administrators

  • MID America

  • MS Administrative Services

  • Mutual of Omaha (refer to Coventry Health Care)

  • National Foundation Life Insurance Co.

  • National Health Insurance / Ecom

  • NCAS

  • New Era / Philadelphia Life / Ecom

  • NGS American

  • Noridian Benefit Plan Administrators

  • North America Administrators

  • NEF

  • Novanet

  • Outsource One Benefits

  • P5 Electronic Health Serices

  • Performax / CHF / Meritain Health

  • Philadelphia American Life

  • Preferred One Administrative Services

  • Principal Life insurance Company

  • Professional Benefit Services, Inc.

  • Professional Claim Administration (refer to Auxiant)

  • Regional Care, Inc.

  • Select Benefit Administrators of America

  • Shasta Administrative Serices

  • Significa Insurance Group

  • Southwest Services Administrators

  • Starmark

  • State General / Ecom

  • Summit Administration Services

  • Tall Tree Administrators

  • Taylor Benefit Resource

  • TBG Administrative Services

  • The Loomis Company

  • Trident Plan Administrators

  • True Choice / Healthscope

  • Trustmark Insurance Company

  • United Health International

  • United Medical Resource (formerly Iasis)

  • United Security Life

  • UMC (formerly Wausau Benefits / Fiserv)

  • Weyco, Inc. / Meritain Health 

  • WMI TPA, Inc.

  • World Insurance (formerly Mid-America)

  • Zenith Administrators, Inc

BLUE CROSS BLUE SHIELD Third Party Payors:

  • AmeriBen Solutions, Inc.

  • Employee Benefits Administration

  • Fringe Benefit Services, Inc.

  • Gilsbar, L.L.C.

  • Health Now Administrative Services

  • Health Smart Benefit Solutions

  • Mayo Management Services, Inc.

  • Meritain Health, Inc.

  • Mountain States Administrative Services, Inc.

  • Pinnacle Claims Management, Inc.

  • Southwest Service Administrators, Inc.

  • Summit Administration Services, Inc.

  • Tall Tree Administrators

  • Web – TPA, Inc.

  • Zenith American Solutions

CIGNA Third Party Payors:

  • Southwest Service Administrators, Inc.

ACPN Third party providers:

             AZ plans: 

  • Alpha Vision Insurance

  • Ameriprise

  • Arizona Metropolitan trust

  • Continued AZ plans for ACPN:

  • Arizona Metropolitan Trust

  • Arizona Pipe trades Health and Welfare Fund

  • Assured Benefits Administrators

  • Basha’s Risk Management

  • Compstar Systems

  • IBEW 640

  • Insurers Admin Corp

  • Plumbers Local 8

  • Plumbers Local 88

  • ProCentury Company

  • Quik Trip Corporation

  • Republic Group

  • Salt River

  • Secura Insurance Company

  • Southwest Service administrators

  • Summit SRT Administrators

  • UFCW Employer Plan

  • Union Standard Insurance Group

  • Western Growers Assurance Trust

National Plans:

  • AHH

  • AIG

  • AIM Benefit Services

  • ALTRUA

  • Ameriplan

And many more. Please call our office or look on the ACPN website for details.

We do accept “out of network” authorizations for private companies we are not contracted with. Please call our office to obtain CPT codes patient will need for you to obtain the auth. Also, we accept self-pay patients. All non-contracted patients will be required to pay in full at time of appointment, and we will courtesy bill for them and refund the deposit.