Billing and Insurance Guide

For more information, you may download a copy of our Billing Guide.

West End Orthopaedic Clinic accepts the insurance plans listed below. If your insurance company is not on this list, or if you do not have insurance coverage, you should ask to speak to the Financial Coordinator when you schedule your appointment.

Even if your insurance company is on the list, it may be in your best interest to contact the company in advance to verify the extent of your coverage and the pre-authorization or co-payment requirements of your plan, if there are any. For your convenience, we have provided web addresses for many of the listed providers.

 

Aetna www.aetna.com
Anthem PAR/PPO/HMO www.anthem.com
Beech Street www.vhn.com
Cigna www.mycigna.com
Coventry [Virginia Plans Only] http://chcvirginia.coventryhealthcare.com
Medicaid [Virginia Plans Only] www.dmas.virginia.gov
Medicare www.mymedicare.gov
Medicare Advantage Plans
  Anthem Preferred www.anthem.com
  Optima Health Medicare www.optimahealth.com
OneNet www.mamsiunitedhealthcare.com
Optima Health HMO/PPO/POS www.optimahealth.com
United Healthcare www.myuhc.com
Virginia Health Network www.vhn.com
Virginia Premier Health Plan www.vapremier.com
Workers' Compensation www.vwc.state.va.us


Frequently Asked Questions

If your question is not among those listed below, please contact the office where your treatment was provided, or choose the Contact Us tab at the top of the this page.

May I schedule an appointment even if my insurance is not accepted?

If your insurance plan is not one West End Orthopaedic Clinic participates with, please do not be discouraged.  We are happy to schedule an appointment for you.  However, it is in your best interest to contact your insurance company to verify whether services provided will be covered.  In these cases, carriers will often process your medical claims as "out of network" which may result in a higher "out of pocket" expense to you.  For benefit information, please call the member services telephone number located on the front or the back of your insurance card.

What methods of payment do you accept?

We accept cash, checks, money orders, and the following credit cards: Visa, MasterCard, and American Express.

 
How can I pay my bill?

West End Orthopaedic Clinic offers several convenient ways to pay your bill:

Pay your bill online by clicking here
Pay your bill in person at one of our clinics. For addresses and directions, click here
Pay your bill by phone: 804-327-9242
Pay your bill by mail: P.O. Box 35725, Richmond, VA 23235

 
Do you offer payment plans?

Yes, we do offer payment plans. If you wish to discuss the availability of a payment plan, please contact one of our experienced Patient Account Representatives by calling 804-327-9242 between 8am and 5pm, Monday through Friday.

 
I do not have insurance. Can I still be treated by a West End Orthopaedic Clinic physician?

Yes, you can receive treatment from us even if you do not have insurance. However, you will be required to pay $100 on your first visit, after which you will receive an uninsured discount off your total charges. If you are unable to meet your financial obligation to us, your account may be sent to an outside collector. If your account goes to an outside collector, the original discount will be voided.

 
Do I need a formal referral in order to receive treatment?

Your insurance company may require a formal referral in order for your treatment to be covered, so you should contact them prior to your visit. If you need a referral but do not have one when you come in for your visit, you may have to reschedule your appointment or pay out of pocket for your treatment. If you have any further questions, please call the clinic where you are scheduled to be seen and ask to speak to the Financial Coordinator.

 
I have insurance. How do I know what my financial responsibility will be?

When you check in on the day of your visit, you will be asked to pay a co-payment. The amount of your co-payment can likely be found on the front of your insurance card. Because our physicians and physician assistants are considered Specialists, the “Specialist” co-payment amount will apply.

Depending on your insurance policy, you may also be required to pay additional amounts called “deductibles” or “co-insurance.” If this is the case, you will be billed once we receive correspondence from your insurance company. For more information about deductibles and co-insurance, contact your insurance company.

 
I received a statement that says I had ‘surgery’ even though I didn’t have an operation. Is this a mistake?

When billing an insurance company, physicians are required to identify the services rendered with codes from the "Current Procedural Terminology" (CPT) book.

The CPT code set was designated by the Department of Health and Human Services as the national coding standard for physician and other health care professional services and procedures under the Health Insurance Portability and Accountability Act (HIPAA).

Services such as joint injections and fracture care are found in the "Surgery" section of this resource book.  For this reason, "Surgery" may be listed on the patient's explanation of medical benefits mailed to them from the insurance carrier.

 
What does global period mean?

Any procedure classified as “Surgery” is assigned a period of time during which additional visits to the same surgeon are considered part of the standard follow-up care and are not billed. This “global period” can vary from 10 days for a simple procedure to 90 days for a more complicated one.

During the global period, West End Orthopaedic Clinic will not ask you to pay a co-payment since treatment for your face-to-face follow-up care with the surgeon is considered part of your original procedure. This does not include additional x-rays or supplies received during the global period. In accordance with your insurance policy, these charges will be billed once you leave the office and as a result, you may endure some financial responsibility.

Follow-up services provided by someone other than the surgeon, such as Physical Therapy and Hand Therapy, are not automatically covered during the global period. Because of this, additional co-payments, deductibles, and/or co-insurance do apply. Co-payments are required at the time of your therapy service.

 
I have a question about a statement I received in the mail. Who should I contact?

If you have questions about your bill, please do not hesitate to contact one of our experienced Patient Account Representatives by calling 804-327-9242 between 8am and 5pm, Monday through Friday.

 

 

We welcome your comments and suggestions regarding the services provided by our Central Billing Office. Please click here to access our PATIENT SATISFACTION SURVEY. Thank you!