Payment & Insurance
PAYMENT & INSURANCE
Great Lakes Orthopaedic Center requires payment of co-pays, deductibles and non-covered items on the day of your visit. Please contact your insurance carrier to verify your benefits prior to your appointment. For your convenience we accept cash, check, Visa, Mastercard, Discover, and American Express.
We participate with the following insurances:
- Aetna/Aetna Medicare Advantage
- Auto (Michigan Only)
- Blue Cross (excluding Blue Cross Detroit Metro)
- Blue Care Network/Blue Care Network Advantage
- Champ VA
- Cofinity (formerly PPOM)
- Humana/Humana Medicare
- Mclaren Health Plan Commerical (non-medicaid)
- Medicaid (counties Anrtim, Benzie, Grand Traverse, Kalkaska and Leelanau Counties Only)
- Medicare Plus Blue
- Priority Health/Priority Health Medicare
- Physicians Care/ASR
- Tricare Standard
- United Healthcare
- VA Hospital/VA Choice
- Workers Compensation (Michigan and Federal Only)
Most insurance companies include their contact information on the back of the insurance card.
If we do not participate with your insurance company, we will bill them one time as a courtesy. You are responsible for any amount they do not pay.
Patients who do not have insurance will be required to pay a deposit of $150 at their initial visit, and will meet with a member of the billing staff to make arrangements for any remaining balance. Payment for surgeries or further treatment will be discussed at that time.
PHYSICAL THERAPY BENEFITS
Questions to ask your insurance company prior to receiving treatment:
1. Is physical therapy a covered benefit?
2. Does physical therapy require an authorization?
3. How many physical therapy visits do I have?
4. How many have I used?
5. What is my co-pay or co-insurance for each visit?
Unfortunately, as a physician practice, we are not an authorized Physical Therapy provider for Medicaid patients due to Medicaid policy.
It is highly recommended that you contact your insurance carrier to verify your benefits and out-of-pocket costs prior to orthopaedic surgery. If a preauthorization is needed, our Billing Department will contact your insurance company and verify your coverage.
The fee charged by Great Lakes Orthopaedic Center for your surgery includes the physician’s fee for performing the procedure as well as normal follow-up visits for 90 days. X-rays, procedures, physical therapy, and bracing or supplies during the pre- or post-op period will be billed separately. Office visits for unrelated conditions will be billed separately as well.
Your surgery may also require the assistance of a Physician Assistant or Nurse Practitioner, which is charged at 20% of the surgical fee. Some policies do not cover this service. Please contact your insurance carrier to verify if this is a covered benefit.
For information on facility and anesthesia charges, please call:
Munson Medical Center: 231-935-5000
Northwest Michigan Surgery Center: 231-392-8900
Traverse Anesthesia Associates: 231-935-5770
FRACTURE CARE BILLING
According to billing guidelines, fracture care is billed as a “package” or “global” service.
This means that at the time of initial treatment the charge includes:
- Evaluation of the fracture
- The application of the first cast or splint
- 90 days of uncomplicated follow-up care
Items not included in the fracture care charge:
- Casting/splinting supplies or bracing
- Any replacement cast or splint
- The evaluation of any unrelated problems or injuries
- Physical Therapy
Please call our office or your insurance company if you have any questions regarding how your services were billed.
NON COVERED SERVICES
Some services provided by Great Lakes Orthopaedic Center may not be covered, either partially or entirely, by certain health insurance programs. Patients will be billed by our office for those services. We suggest that patients contact their insurance company to verify coverage for specific services.
You may be asked to sign an ABN (Advance Beneficiary Notice) for any service or product that may not be covered by insurance. Your signature acknowledges that you will be held personally and fully responsible for payment.
PERSONAL RECORD SERVICES
Great Lakes Orthopaedic Center can provide further information for your personal records. Please be aware that additional charges may apply and insurances may not cover these charges.
- Copies of Medical Records ($1.09 per page, with a cap of $25.00)
- Copies of X-Rays on a disc (1st copy $10.00, additional copies $5.00)
- Disability Forms / Insurance Forms ($25.00 per form)
- Nurse Case Manager Fee ($25.00)
- Waterproof Cast Liners ($15.00 – $60.00)
- Cast Covers ($30)