With so many specialists out there, sometimes it can be confusing to know who to go to for your pain. Orthopaedic doctors deal with a wide variety of musculoskeletal conditions and soft-tissue injuries. Most sports injury doctors are orthopedic doctors, along with surgeons that operate on joints and broken bones. That covers a lot of pain and injury cases, so it may seem logical to head straight to an orthopedic doctor. However, you may need a referral to see an orthopedic specialist, depending on your insurance plan.
Many plans, particularly Preferred Provider Organizations (PPOs), allow you to see a specialist directly. Other plans, like Health Maintenance Organizations (HMOs), typically require a referral from a primary care physician (PCP) before you can see a specialist. You can see what type of plan you are on normally by looking at your health insurance card. However, if you want more confirmation on specific questions, contact your insurance company. You can always talk to them in order to understand your specific plan’s requirements and ensure the specialist you want to go to is in-network.
Additionally, the specialist that you want to see will also have to accept your insurance. You can usually find this information on their website, but can definitely call and ask as well. Orthopaedic Specialists accepts most insurance plans, with the exception of Medicaid and Passport insurance plans.
Other Plans:
Some plans, like Medicare Advantage plans, may have their own referral or prior authorization requirements.
How to Find Out if Your Insurance Plan Has Their Own Referral Process:
- Check your Insurance Card: Your insurance card often has your plan details and the phone number for your insurance provider.
- Call Your Insurance Company: If you cannot locate your plan details, contact your insurance provider directly and ask about the referral requirements for seeing an orthopedic specialist under your specific plan.
- Visit Your Insurance Provider’s Website or Mobile App: You can often find detailed information about your plan and its requirements online or on a designated app that you log into for personal account details.
Important Considerations
Orthopedic doctors can help you with a lot of different aches, pains, and injuries. However, you are the one who ultimately decides if a specialists is the right choice for you and your situation. Out-of-network costs can affect a lot of medical decisions. Even in-network specialists may have caveats, like co-payments or other fees. Be sure to do your research before visiting to avoid any unexpected costs. Of course, if you do not have health insurance or your insurance plan does not cover an orthopedic doctor, you will usually have a self-pay option like you do at Orthopaedic Specialists.
What To Bring if Your Visit is Covered By Insurance
At Orthopaedic Specialists, if your visit is covered by insurance, we ask that you arrive ten minutes early to fill out paperwork and bring the following to your first appointment:
- Shorts or sleeveless shirt if being seen for your knee or shoulder.
- Insurance card or worker’s compensation information.
- Government issued ID; example: driver’s license.
- Preferred pharmacy location information.
- Co-pay if required, cash, check or credit card (Visa, Mastercard, Discover accepted)
- Prior imaging studies if possible.
- Prior Orthopaedic medical records if possible.
- List of current medications.
If you need help getting a referral, give us a call! We’ll be more than happy to talk to you about your options.
If you or someone you love has suffered an injury in the Louisville, Kentucky-area, board certified sports medicine physician Dr. Stacie Grossfeld at Orthopaedic Specialists PLLC can help. Orthopaedic Specialists PLLC is accepting new patients, and same day appointments are available. For additional information or to schedule an appointment, please contact Orthopaedic Specialists PLLC today at 502-212-2663.
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