Business Office FAQs

It's quite common to have questions about billing statements or insurance explanation of benefits and we are glad to help.  We've posted some frequently asked questions (FAQs) below to help you get your questions answered. Please feel free to call us at 303-233-1223.

Business Office FAQs  

Q. Why do I have to pay a co-pay?
A. Panorama Orthopedics & Spine Center does not make determinations about co-payments; this is determined by your specific insurance plan.  We have signed an agreement with the insurances we participate with to collect a co-payment for any charges incurred during your visit.  It is the patient’s responsibility to pay their co-payment at the time of service.

Q. Why did I receive separate bills for the hospital and the doctor(s)?
A. Panorama Orthopedics & Spine Center only bills for the surgeon’s part of the surgery; there is a separate charge for the facility (hospital or surgery center) for their service during the surgery.  In some cases, there may also be a separate charge for the anesthesiologist’s service during the surgery.

Q. How can I make payment arrangements?
A. Panorama Orthopedics makes every attempt to assist patients with their financial needs. Our payment plans vary, but we normally ask for half of the payment on, or before, the date of service, with monthly payments to be completed within 90 days of the date of service. We do offer discounts for patients that pay in full at the time of service.

Q. What is a deductible?
A. Deductibles are provisions that require the member to accumulate a specific amount of medical bills before benefits are paid. For example, if a member’s policy contains a $500 deductible, the member must accumulate and pay $500 out of pocket before the insurance carrier will pay benefits. Once the patient has met their deductible, the carrier usually pays a percentage of the bill. The patient is liable for the unpaid percentage. Deductibles are yearly, usually starting in January.

Q. What is co-insurance?
A. Co-insurance is a form of cost-sharing. After your deductible has been met, the plan will begin paying a percentage of your bills. The remaining amount, known as co-insurance, is the portion due by the patient.

Q. Why did my insurance company only pay part of my bill?
A. Most insurance plans require you to pay a deductible and/or co-insurance. In addition, you could be responsible for non-covered services. Please contact your insurance company for specific answers to your questions. You may have out-of-pocket expenses.

Q. Will you bill my primary and secondary insurance?
A. You will need to provide us with complete primary insurance information. As a courtesy to our patients, Panorama submits bills to your insurance company and will do everything possible to advance your claim. However, it may become necessary for you to contact your insurance company or supply additional information to them for claims processing requirements or to expedite payment.

Q. What is included in “Fracture Care”?
A:  Fracture care is coded such that follow-up care is included in the “global” charge.  This means that the physician’s care is billed using the first date of service as the date incurred, and there would be no further charge for their professional services during a specified, global, follow-up period.  Charges for additional services, however, are billed in the usual manner (for instance, x-rays, supplies, etc.)

Q:   Why did my private insurance company not pay or cover my entire bill?
A:  There really is no one simple answer to this question.  Some of the reasons you may be left with a patient balance are due to charges being applied to the policy coinsurance, deductible and/or copay.  Another may be your insurance company applying a “usual and customary clause” to your claim.  This is a frequent ploy used by insurance companies to justify cutting reimbursement to their insured’s for legitimately incurred medical charges.  Since every policy (and there are thousands of them), defines “usual and customary” differently, they have no bearing on ours, or any physicians’, fee schedule.  Since in most cases, we do not have a contract with the insurance company, their contract, and responsibilities lie with you, their insured customer.  As you can see, the best answer to this question would be to contact your insurance company for an explanation of your policy.  We will do our best to assist you if you are having problems dealing with them, but the ultimate responsibility would lie with you, their insured member.

Q. What is a tort auto insurance system?
A. This is a system where the driver who is at fault for causing a traffic crash is responsible for paying the victim's medical expenses and compensating for additional damages.

Q. How do my medical bills get paid under a tort system?
A.  Drivers are required to carry liability coverage to pay for injuries and damages, so the insurance company of the driver who causes the accident will be responsible for paying the medical bills. Most drivers in tort states also carry some medical payments coverage, which pays for the medical expenses of the injured person regardless of who is at fault. Most drivers carry health insurance of some kind, so they could rely on their health insurance after the medical payments coverage, if needed. Then, if it becomes clear that someone else was at fault, the health insurer can seek reimbursement from the at-fault driver.