Insurance and Fees

We strive to help you in every way possible and request that you provide us with paperwork that is appropriate. Your insurance plan may require prior approval for surgery, medications, some diagnostic tests, therapy, etc. At South Bend Orthopaedics, we do have a special department that will obtain these authorizations for you.

It is very important that you bring your insurance card with you at the time of your appointment. This enables our staff to have the information that is needed to obtain these approvals and also to direct your care to an in-network provider if you have a PPO or an HMO insurance plan. If you are coming from a referring physician, please bring the completed form with you.

We will file all claims with your insurance company within a week of your office visit. We also forward a letter to your physician outlining your evaluation and treatment plan. It is very important that you be familiar with the specifications of your insurance coverage, particularly the limitations of coverage.

Participating Insurance Plans

South Bend Orthopaedics works with the following insurance plans and carriers. This list may change without notice, so please contact our office for specific insurance plan coverage.

  • Advantage HMO and POS
  • Advantage Preferred Plus
  • Aetna - Most Plans
  • Anthem BCBS PPN, PCI, Blue Access PPO
  • Choicecare
  • Cigna - Most Plans
  • Community Health Alliance
  • Encore/Superion
  • First Health/CCN
  • Goshen Preferred Network
  • Healthstar/PPO Next
  • Healthy Indiana Plan: Anthem and MHS
  • Indiana Medicaid: Traditional, Care Select, MHS, Anthem
  • Medicare: Traditional and Most Medicare Advantage Plans
  • PHCS
  • PHPNI-Physicians Health Plan of Northern Indiana
  • Sagamore PPO
  • Select Health Network
  • Signature Care
  • St. Joseph Health Center
  • Standard Champus or Tricare Standard
  • Teamcare Local 364
  • United Health Care

Work-Related Injuries

If you have suffered a work-related injury, please provide us with a written acceptance of financial responsibility from your employer or your employer’s Workman’s Compensation Insurance provider. Click here to learn more about our Work Comp Program.

Disability

If you are on disability, we will complete the appropriate forms and mail them within 10 days.

Fees

We require that fees for services be paid at the time of service. Should this be a problem, please contact our Administrator or Patient Account Representative at (574) 247-9441 .

Specialized Insurance Reps

We offer specialized insurance representatives for most major insurance payors to assist patients with questions about insurance guidelines and payments. Please call (574) 247-9441.

Credit Policy

We share our patients’ concern over the increasing costs of medical care and thus we strive to keep our fees reasonable and customary. If you have any questions about your bill with South Bend Orthopedics, please ask us. You are responsible for payment of your account even if you have insurance; your insurance contract is an agreement between you and your insurance company.

Depending on your contract with your insurance company, you may be required to make a co-payment or pay a deductible amount. Co-payments are required on the date of service. Insurance payments paid directly to South Bend Orthopedics will be applied to your account. If there is a balance remaining you will receive a billing statement.

Billing

Our statements are sent out on a monthly basis through our business office. All charges are due and payable within 30 days of receipt. We accept cash, check, Visa, Master Card, and money orders for payment on your account.

Please contact us if payment in full would be a financial hardship, we will set up a payment arrangement with you. For further assistance please contact our business office at (574) 247-9441.

Office hours are 8:00 a.m. to 5:00 p.m., Monday through Friday. You may leave a message after hours.

Referrals

If your insurance plans require a referral for you to see a physician at South Bend Orthopaedics; this must be obtained from your primary care physician. Patients are responsible for making sure a referral is in place before services are received. Our business office has referral coordinators available if further assistance is needed. For assistance call (574) 247-9441.

Appointment Cancellation Policy

Our goal is to provide quality medical care in a timely manner. In order to do so we have had to implement an appointment cancellation policy. This policy enables us to better utilize available appointments for our patients in need of medical care.

In order to be respectful of the medical needs of the South Bend Orthopaedics please be courteous and call promptly if you are unable to attend an appointment. This time will be reallocated to someone who is in need of treatment. This is how we can best serve the needs of all our patients.

If it is necessary to cancel your scheduled appointment we require that you call by 10 a.m., one (1) working day in advance. Appointments are in high demand, and your early cancellation will give another person the possibility to have access to timely medical care.

[Top]