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Insurance and Billing

We Want To Get You The Care You Need!

At Vail-Summit Orthopaedics & Neurosurgery, every patient — regardless of financial means and social status — is treated equally with kindness and compassion. VSON's ultimate goal is to provide you with the highest-level orthopaedic care so you can get back to the activities you love. Our billing and insurance department is here to help you get the treatment you need.

Contracted Insurance Plans

Vail-Summit Orthopaedics & Neurosurgery is contracted with the following insurance companies: 

COMMERCIAL PATIENTS

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  • Aetna- PPO, Managed Choice, Elect Choice (EPO) and HMO- 

  • Blue Cross Blue Shield 

  • BCBS Blue Card (Out of State) 

  • BCBS Federal

  • BCBS HMO (Colorado Only) 

  • BCBS Pathway Essentials/Mountain Enhanced

  • BCBS Pathway HMO/PPO/EPO 

  • Champ VA

  • CHP+ Colo Access

  • CHP+ United Healthcare Community Plan/Rocky Mountain Health Plans

  • Cigna PPO, Open Access Plus, Local Plus and Local Plus IN   

  • EBMS 

  • First Health Network 

  • Lucent Health Partners 

  • Meritain

  • Multiplan/PHCS

COMMERCIAL PATIENTS (CONTINUED)​

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  • PNOA- Provider Network of America

  • Rocky Mountain Valley (Gunnison)  

  • Rocky Mountain Sky (Eagle and Summit County)

  • Tricare 

  • TriWest Healthcare Alliance (Referral Needed)

  • UCHealth

  • Workers Compensation (Colorado Only)

  • UMR

  • United HealthCare 

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MEDICARE PATIENTS​

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  • AARP Medicare Advantage HMO- 

  • Medicare

  • Railroad Medicare

  • Cigna Medicare Advantage

  • United HealthCare Medicare Advantage

  • United Healthcare/ Rocky Mountain Health Plans 

Insurance plan contracts change so frequently that it is best to confirm our participation directly by contacting your insurance company or by calling our business department at (866) 358-0202.

Other Insurance Plans

There are many insurance plans that we are not contracted with. As a courtesy to our patients, we will bill these insurance carriers on your behalf; however, if the insurance carrier does not process the claim in a timely manner (60 days from the time the bill is properly submitted), we will contact you for payment on your account.

Copays
and
Deductibles

Many insurance carriers require that we collect co-pays and/or deductibles from the patient. Federal laws, as well as our individual agreements with the insurance carriers we are contracted with, prohibit us from waiving these fees.

Referrals and Pre-Authorizations

Many insurance plans require referrals and/or pre-authorization for certain services and/or procedures. While we make every effort to ensure your services will be covered, it is ultimately your responsibility to ensure the terms of your insurance plan are met.

Explanation of Benefits and Statements

In most cases, you will receive an EOB (Explanation of Benefits) from your insurance carrier. The EOB will generally outline what was billed, what was paid, and what we can or cannot bill to the patient. These forms vary greatly from plan to plan and contain a lot of terminology you may not be familiar with. If you have any questions regarding an EOB you have received, please contact our business department at (866) 358-0202. We would be happy to assist you. You will receive a statement for unpaid balances on your account. Items pending from the insurance company will NOT show on your bill. If you have questions about your statement, please contact our business department at (866) 358-0202.

Right to Receive Good Faith Estimate

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost. 

 

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

 

  • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services.  This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.

  • If you schedule a health care item or service at least 3 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 1 business day after scheduling.  If you schedule a health care item or service at least 10 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after scheduling.  You can also ask any health care provider or facility for a Good Faith Estimate before you schedule an item or service.  If you do, make sure the healthcare provider or facility gives you a Good Faith Estimate in writing within 3 business days after your ask.

  • If you received a bill that was at least $400.00 more than your Good Faith Estimate, you can dispute the bill.

  • Make sure to save a copy or a picture of your Good Faith Estimate.

 

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gove/nosurprises or

call 1-800-985-3059.

Payment Plans

If you are uninsured or are responsible for a portion of your services, you will be expected to make payment at the time of service. If you are unable to pay your portion at the time of your visit, please contact our business department prior to your appointment to discuss payment options. Failure to do so may require us to reschedule your appointment. Our business department will make every effort to arrange a reasonable payment schedule for the services you require.

Refunds

In the event that you or your insurance company has overpaid on an account, we will process a refund check for the appropriate payee in a timely manner.

Transparency in Healthcare Prices

Vail-Summit Orthopaedics & Neurosurgery is required by Senate Bill 17-065 to post the most frequent codes/procedures billed to patients. In order for VSON to comply with this bill, we are providing our patients with a list of the 15 most billed codes. 

 

All healthcare pricing is an estimate, and the actual charge for services is dependent on the circumstances at the time that the service is rendered.

 

If you are covered by health insurance, you are strongly encouraged to consult with your health plan to determine accurate information about your responsibility for a particular service provided by VSON. If you are not covered by health insurance, you are strongly encouraged to contact our billing office at (866) 358-0202 to discuss payment options and potential self-pay discounts available to you prior to receiving any services from VSON.

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