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Insurance

The Hedley Orthopaedic Institute, a Physician Group of Arizona, Inc., practice, currently accepts the following health plans:

AHCCCS Plans

Acute Care Health Plans in Maricopa County

Health Net Access
Health Choice
Maricopa Health Plan
Mercy Care Plan
Mercy Maricopa Integrated
Phoenix Health Plan
United Healthcare Community Plans

Long Term Care Plans in Maricopa County

Bridgeway Health Solutions
Mercy Care Plan – LTC
United Health Care – LTC

Regional Behavioral Health Authority (RBHA) in Maricopa County

Mercy Maricopa
Mercy Maricopa Integrated
Gila River Indian Tribe

Regional Behavioral Health Authority (RBHA) in Coconino County

Health Choice Integrated Care

Acute Care Health Plans in Pima County

University Health Plans

Aetna

Aenta US Access
Aetna QPOS
Aetna PPO
Aetna Medicare
Aetna HMO
Choice POS
Aetna Select
Managed Choice POS
Open Access Aetna Select
Aetna open Access Elect Choice
Aetna open Access Managed Choice
Open Choice PPO
Aetna HealthFund PPO
Aetna Healthfund POS
Aetna Performance Network (ortho only)
Aetna AExcel Plan (effective 1-1-2016, Ortho and Plastic only)
AetnaChoice POS II 

BCBS

BCBS of AZ Workers Comp
BCBS of AZ– Senior Preferred
BCBS of AZ Par (Indemnity)
BCBS of AZ and other BCBS – PPO
BCBS of AZ HMO
BCBS Select Exclusive Network

Bridgeway

Medicare Advantage
Medicaid

Cigna

Cigna Healix

Health Choice

Health Choice Preferred
Health Choice Arizona – Medicaid
Health Choice Generations – Medicare
Health Choice Insurance Co.
Health Choice Integrated Care – RBHA in Northern Arizona

Health Net

Health Net PPO
Health Net PPO/HAS
Health Net Commercial – IFP and SBG
Health Net Direct HMO
Health Net POS
Health Net Community Care HMO
Health Net AHCCCS
Medicare Through AZPC

Hawaii Mainland Network (HMN)

Humana

Humana Community HMO
Humana Community HMO Diabetes and Heart (HMO and SNP)
Humana Gold Plus HMO
Humana Gold Choice PFFS
Humana Choice PPO Commercial
Humana Premier
Humana HMOx
National POS – Open Access
Choice Care PPO
Humana One

Medicare

Mercy Care

Mercy Care Advantage
Mercy Care Plan
Mercy Care Acute
Mercy Care Long Term Care
Mercy Care DDD
Mercy Care GMHSA

Mercy Maricopa Integrated Care (MMIC)

Mercy Maricopa integrated
Mercy Maricopa GMHSA

UnitedHealthcare

UnitedHealthcare Medicare Advantage Plans

Triccare
Commercial HMO
Commercial PPO
Commercial Compass
Commercial Navigate
Medicare
Community Plan AHCCCS
Community Plan DDD
Community Plan LTC
Community Plan Dual Complete

The list above represents the health plans accepted by most physicians affiliated with Physician Group of Arizona, Inc. Please note that the listing of a health care plan does not guarantee coverage. If your managed health care plan is not listed, please contact your insurance provider. Some affiliates may not be listed.

Insurance Verification

You must provide our office with your insurance verification card. Should you change your insurance coverage, please contact our office with any updated insurance information. We also recommend that you contact your insurance company prior to surgery to determine the extent of your coverage, including:

  • Anesthesiology
  • Diagnostic testing
  • Hospitalization
  • Physical therapy
  • Recovery
  • Rehabilitation (needs, equipment)
  • Second opinion requirements
  • Surgeon fees
  • Surgery

Please note, verification and/or pre-certification is not a promise of payment from your insurance company. You are still responsible for payment of the bill. To assist, we will submit a claim for any services to your primary insurance carrier and provide you with the information you may need for secondary insurance. If you have additional questions, please contact us.

Payment Policy

You are personally responsible for payment of your account regardless of your medical insurance coverage. Our policy requires that all office visit charges be paid at the time of service. We accept cash, personal checks, Mastercard and Visa for payment of charges. You will receive a monthly statement itemizing charges and your current balance. Any arrangements for extended payments must be addressed with our business office at 602-553-3113. If your account is past due and you have not made payment arrangements with the business office, we will need to take additional collection measures.

Surgery Deposit

A deposit may be required prior to your surgery, depending on your type of insurance coverage. If a deposit is required, you will be contacted by the business office prior to surgery.

Postoperative Charges

Office visits following surgery are included in your surgery fee for a specified period of time (usually up to 90 days), depending on the type of surgery performed. X-rays and other services or supplies provided after surgery are not included in the surgery fee and are your responsibility to pay..

Medicare

We accept Medicare. Medicare will pay us directly for 80 percent of the allowed charges. You are responsible to provide payment of the remaining 20 percent of Medicare’s allowed charges, if your deductible has been met. We will provide you with the information you may need for your supplemental insurance carrier.

Workman’s Compensation

On your first visit for an industrial injury, you must complete a 102-Form. If you have not completed this form, please speak with the practice’s industrial account representative. Information and forms must be submitted to the receptionist at the time of check-in.

HMO/PPO Plans

We are contracted with certain managed health care plans to accept their established fee schedule amounts. The various plans have different deductible, co-payment and co-insurance requirements, which you must pay at the time of service. Please familiarize yourself with your plan’s financial requirements as well as protocol requirements for referrals, preauthorization and second opinions.

Indemnity Plans

Indemnity insurance plans pay according to their reasonable and customary fee schedules. We are not contracted with these insurance companies. You are responsible for paying the difference between the practice’s charges and the insurance plan’s reimbursement.

For more information or to schedule an appointment, please contact us.

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