Insurance & Billing

Fees and Payment

Our fees are based upon reasonable and customary charges prevailing in this area, and take into account the complexity of a particular problem. Fees for a new visit or new problem are higher than for a routine follow-up because more time and resources are required to diagnose and treat a new problem than to follow an existing one. If you have any questions regarding the fee for a particular problem, please feel free to ask our staff for clarification.

The amount that you will have to pay will depend on if you have insurance or not and what your individual insurance benefits are. All insurance policies are verified at the time of your visit but we are only provided with an estimate from your insurance company, no benefits are guaranteed until the claim is processed. You will be responsible for any Co-payment, Deductible or Co-Insurance percentage that your insurance company advises our office that you should be responsible for. If you do not have insurance a $250.00 deposit is required, which will normally cover your first visit and an x-ray, you will be responsible for any additional treatment costs such as injections, casts or splints at the time the treatment is rendered.

For planned surgery, we will contact your insurance company to verify your benefits and any co-insurance amounts you will owe. A pre-surgical deposit may be required based upon these verified benefits.

The Insurance Company and You

Frequently health insurance companies may pay only part of the physician’s fee for services. Certain insurance companies will not reimburse you for items such as braces or splints (Durable Medical Equipment / DME). The extent of your benefits is determined by your individual policy. Please keep in mind that services have been rendered to you, the patient, not the insurance company, and you are ultimately responsible for any outstanding balance on your account. We allow thirty (30) days for submission and processing of insurance claims.

We are happy to assist you with any questions regarding claims with your insurance company. Please contact our billing office at (504) 897-0674.

If multiple attempts to collect payment from you are unsuccessful, we reserve the right to turn the outstanding balance due over to a collection agency. In addition to the principal balance due, you will also be responsible for any interest accrued plus any legal or collection agency fees incurred.

We currently accept Medicare and participate with most insurance plans. Please click here to see a full list of insurance plans that we participate with. The patient is responsible for any co-pay, deductible or co-insurance balance.

Patient Rights

  • To receive services without regard to race, color, age, gender, sexual orientation, religion, marital status, handicap, national origin or sponsor.
  • To be provided reasonable physical access
  • To be provided a safe environment
  • To be provided with appropriate privacy
  • To be treated with respect, consideration and dignity
  • To expect all disclosures, communications and records are treated confidentially, except when required by law, and to be given the opportunity to approve or refuse their release.
  • To be provided, to the degree known, complete information concerning your diagnosis, treatment and prognosis. When it is medically inadvisable to give such information to a patient, the information is provided to a person designated by the patient to be a legally authorized person.
  • To be given the opportunity to participate in decisions involving their health care, except when participation is contraindicated for medical reasons.

Insurance & Billing

To meet the needs of our growing patient population, Southern Orthopaedic Specialists, a division of LMG, LLC, strives to participate with most health insurance companies. Healthcare is an ever-changing environment, therefore, we suggest that you consult your insurance company to determine if we are providers for your specific plan.

We accept the
following insurances:

Aetna – HMO, POS, Elect Choice, Managed Choice POS, Aetna Choice POS II, Aetna Select, Open Choice PPO, National Advantage, Medicare Advantage HMO, Medicare Advantage PPO and Medicare Advantage POS

Blue Cross Blue Shield – HMO Louisiana, Preferred Care PPO and Blue Connect

Office of Group Benefits – Pelican HRA 1000, Pelican H.S.A 775, Magnolia Local, Magnolia Local Plus, and Magnolia Open Access

Cigna – HMO, PPO, and Open Access Plus

Coventry Healthcare –HMO, PPO, POS, and Medicare Advantra HMO

FARA

Humana – PPO, HMO, HMO-X, POS, EPO, Medicare PPO, Medicare POS, Medicare HMO, Humana Gold Plus

Louisiana Medicare

LWCC

PPO Plus

United Healthcare – Note: Compass plan usually requires a referral from your PCP
*We are not in network with United Healthcare Community Plan

Vantage

Wellcare

Workers Compensation – Louisiana Only

Note:
- We will accept Tricare/ Champus products on an out-of-network basis
- Tricare Prime has no out-of-network benefits*