Millions of
people use a form health insurance to cover necessary medical expenses for both
preventative and unexpected care. Each health insurance policy is different
with various factors to consider when seeking treatment. As a participant in
sports, the need for quality medical care from orthopedic
sports specialists may be needed to return to the game or activity with the
shortest amount of recovery time.
Health
insurance coverage for a sports medicine specialist may require following
specific guidelines as outlined in the policy. Speaking with the insurance
representative or courteous medical staff will help determine what steps are
necessary for successful coverage.
Referrals
Under some
insurance policy guidelines, a referral from the primary care physician is
required prior to visiting a sports medicine specialist. The referral is to
verify the need for a specialist is a medical necessity. Under most
circumstances, the primary care physician is the one who suggests a specialist
is needed for optimal care. The primary care physician may arrange the
appointment as the next step in the treatment process. Without verification,
medical insurance may not pick up the costs of the initial doctor’s
consultation.
Authorization
After the
initial consultation is approved, further authorization may still be required
for treatment. Most sports medicine specialist will have highly trained support
staff to work with authorization requirements from insurance companies.
Acquiring authorization will allow an athlete or sports participant to
concentrate on the treatment program, including:
•Physical or
occupational therapy to help restore strength back to an injured area
•Medical
equipment, bracing, and other support aids to use during the healing process
•Diagnostic
tests to achieve an accurate diagnosis to outline a treatment program approach
•Surgical
procedures, joint replacement, open surgery or arthroscopy
The type of
medical authorization needed for treatment will be different for each person.
After a precise diagnosis, the treatment process may involve a combination of
medical approaches to ensure the highest level of care.
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Deductibles and Co-Pays
Along with
the referral and authorization process, an insurance policy may require a patient
to cover deductibles and co-pays. Calling the insurance provider’s customer
service representative will provide an understanding of the amount of out of
pocket expenses to expect when visiting a sports medicine specialist.
•The
deductible is a percentage amount of the medical expenses a patient is required
to pay until a specific deductible is met
•When a
patient reaches the deductible, the medical insurance will pay the remaining
amount
•Co-pays are
a flat rate to be paid by the patient for medical procedures, prescription,
appointments, and other relatable expenses
•Co-pays to
a sports medicine specialist are usually low when other insurance guidelines
are followed
Leading Sports Medicine Specialists
With a
longstanding consistent practice, Dr.
Howard Marans and his friendly staff understand all the various aspects
relating to
health insurance coverage. Dr. Howard Marans regularly works with numerous
medical insurance carriers – including PPOs. The Doctor provides every patient
with the highest level of treatment and care for a sports related injury
without creating a burdening medical expense. Please click below to schedule
your consultation or call us at 714.979.8981.
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