Insurance
Knowing medical billing and insurance can be confusing, and often lead to frustration, we are here to help. Find out contact information and answers to common questions on this page, and find out how to pay your bill on our Bill Pay page.
Contact Information
Call the number or go to the webpage to get answers to common questions.
| Question About | Telephone Number | Website |
| Statement Received | 844-493-7933 | MyChart |
| Making a Payment | 844-493-7933 | Bill Pay |
| Account in Collections | 804-486-6924 | MyChart |
| Financial Estimate | 804-486-6924 | MyChart |
| Self-Pay Pricing | 804-486-6924 | Self-Pay Pricing |
Participating Insurance Plans
OrthoVirginia participates, and is in-network, with various plans administered by the following organizations. If you do not see your insurance company listed below, OrthoVirginia may be considered out-of-network. It is your responsibility to be sure a provider is in-network and if services are covered under your plan. If your doctor is out-of-network, you will likely incur a higher out-of-pocket cost. If you have any questions regarding your current insurance policy benefits, you should call the Member Services number listed on your insurance card or use their online portal.
Government Plans
- Medicare
- Medicare Railroad
- Medicaid of Virginia
- Tricare/Humana Military
Medicare Advantage Plans
- Aetna
- Anthem Dual Advantage
- Anthem Extra Help
- Anthem Grocery
- Anthem Medicare Advantage
- Clear Spring Health
- Humana
- Kaiser Permanente Senior Advantage
- Molina Complete Care
- Sentara Medicare Prime
- Sentara Medicare Salute
- Sentara Medicare Savings
- Sentara Medicare Value
- United Healthcare
Medicaid of Virginia HMOs
- Aetna Better Health (*CCC)
- Anthem Healthkeepers Plus (*CCC)
- FAMIS PLUS
- Humana Gold Plus
- Molina Complete Care
- Sentara Community Plan (Cardinal Care)
- Sentara Community Complete
- Sentara Community Complete Select
*CCC: Medicaid Commonwealth Coordinated Care Plus Plans
Commercial Health Plans
- Accountable Care Management Group (ACMG)
- Aetna
- Anthem (PAR/PPO/FEP)
- Anthem Healthkeepers (HMO)
- Carefirst
- Cigna
- Cigna Connect
- Custom Ink
- Kaiser Permanente (Northern Virginia area only)
- MedCost/Virginia Health Network
- Oscar (Virginia Plans, HCA Hospitals, Richmond area only)
- Piedmont Community Health Plan (Lynchburg and Southwest Virginia areas only)
- Prime Health
- SaveATree
- Sentara Individual & Family
- Sentara Plus
- Sentara POS
- United Healthcare
Financial Policy
Insurance Coverage
Your health insurance policy is a contract between you and your health insurance company. It is your responsibility as the Policyholder/Patient to understand your coverage and benefits and to be knowledgeable of any deductibles, copayments, and/or coinsurance. Please provide us with your current insurance information prior to, or at the time of, each visit. We must be able to verify your eligibility prior to your visit or your appointment may be re-scheduled. Likewise, failure to inform us of a change in insurance/insurance information may result in exceeding the limits of the time allowed to file a claim and you will be responsible for the charge(s).
Assignment of Benefits
I authorize direct payment from my insurance plan to OrthoVirginia. I understand that it is my responsibility to provide accurate insurance information and to secure all necessary prior approvals, authorizations, and referrals as required by my contract with my insurance company.
Payments
All co-payments and past due balances are due at the time of service. In addition, we may collect a portion of your deductible if it has not yet been met. We accept cash, check, or most major credit cards. Otherwise, you will receive a bill for remaining balances. The full balance is due within 30-days of receipt of the statement. Failure to do so may result in further collection activity which may include referral to an outside collections vendor and/or inability to schedule any further appointments. If you are unable to pay the full amount within 30-days, please contact our billing office to discuss payment plan options.
Self-Pay
Self-pay patients are those patients without insurance coverage, are receiving a service not covered by their plan, or have elected to waive filing via their plan. At a minimum, self-pay patients are required to pay a deposit prior to, or at the time of, each visit. For estimates, or rate inquiries, please have CPT code(s) expected to be charged and visit the self-pay pricing page or call (804) 486-6934.
Note: OrthoVirginia does not provide financing but does afford hardship exemption providing specific criteria is met.
Third Party Payments
OrthoVirginia will not hold your account open during any period of litigation or negotiation where there is a third party involved [such as an auto policy] and may pursue collection action against you during that period.
Right to Choose Your Facility
OrthoVirginia is a physician owned practice. Our physicians also own outpatient surgery centers, MRI facilities, and physical therapy clinics associated with OrthoVirginia. Because our physicians own these services, they are best able to ensure that the highest level of care is provided to you. You can ask that services be provided at locations other than those owned by OrthoVirginia.
Missed Appointments/Cancellations
Our office policy requires at least 24 hours’ notice of cancellation of a booked appointment. Failure to provide adequate notice may result in a missed appointment fee from your provider.
Returned Checks
There will be a $50 fee for insufficient funds.
Consumer Rights
Notice of consumer rights (PDF)
Frequently Asked Questions
Yes, even if OrthoVirginia does not participate in your insurance, we can schedule an appointment for you. You will want to contact your insurance company to see if the services that OrthoVirginia provides will be covered.
When you go to an office that does not participate in your insurance, your insurance company will usually process your medical claim as out of network, which may cause higher out-of-pocket expenses for you and cost more. For specific information, please call the member services telephone number on your insurance card.
Yes, we will schedule new patient appointments even if you do not have insurance. When you make the appointment with our call center, the person you talk to will give you more details about the payment requirements.
Your insurance company may require a referral in order for your treatment to be covered by insurance. OrthoVirginia does not require a referral for you to be seen. You should contact your insurance company before your appointment with OrthoVirginia to see if your insurance company requires a referral. If your insurance company says you need a referral but you 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 been in an auto accident, you will need to file a claim with your car insurance company. We will not file with car insurance. However, if your health insurance should be filed for an auto accident, please take the extra step to contact your insurance company for verification and then contact our billing department by calling 844-493-7933.
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. Our physicians and physician assistants are considered specialists. Therefore, 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, please contact your insurance company.
If you are planning for 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. For major expenses such as emergency surgery, fracture care or elective surgery we will work with you to ensure that you are able to get all benefits your insurance company owes you and that you are able to pay your OrthoVirginia bills.
Please call the business office at 844-493-7933 to communicate changes to your insurance information, phone number, mailing address, or email address.
Short answer: No.
Long answer: When sending a bill to an insurance company, physicians are required to identify the services that a patient received using codes from the “Current Procedural Terminology” (CPT) book.
The U.S. Department of Health and Human services decided on the CPT code set as the national coding standard for physician and other healthcare 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 explanation of medical benefits that your insurance company sends to you.
Any procedure classified as “Surgery” using the CPT book (see question above) 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, OrthoVirginia 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. Additional x-rays or supplies that you receive during the global period are in a separate category from the visits. You may be billed and have to pay for the x-rays or supplies depending on your insurance plan.
Follow-up services provided by someone other than the surgeon, such as a physical therapist or hand therapist, are not automatically covered during the global period. Because of this rule, additional co-payments, deductibles and/or co-insurance do apply. Co-payments are required at the time of your therapy service.
If you have questions about your bill, please contact our business office by calling 844-493-7933 or via MyChart