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Insurance and Billing

At Vail-Summit Orthopaedics & Neurosurgery, we strive to provide every patient with compassionate, world-class orthopedic care. Our goal is to help you return to the activities you love as quickly as possible. Our billing and insurance team is here to assist you in navigating the financial aspects of your care.

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Important Note: Insurance plan contracts change frequently, so we recommend verifying our participation directly with your insurance company by providing our Tax ID 68-0501385 or by contacting our business department at (866) 358-0202. For patients with HMO insurance, please ensure you have obtained a referral from your HMO provider, as it is required for your visit.

Insurance Coverage

We work with the following insurance carriers:

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 

  • Kaiser Choice PPO

  • 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 (expect Dr. Braxton)

  • TriWest Healthcare Alliance (Referral Needed)

  •  UCHealth

  • Workers Compensation (Colorado Only)

  •  UMR

  • United HealthCare 

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MEDICARE PATIENTS (EXCEPT DR. BRAXTON)

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We also accept the following Medicare plans:

  • AARP Medicare Advantage HMO

  • Cigna Medicare Advantage

  • ​Kaiser Senior Choice Advantage PPO

  • Medicare

  • Railroad Medicare

  • 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

If your insurance company is not listed here, we will still submit claims on your behalf as a courtesy. However, if the claim is not processed within 60 days, we will contact you for payment.

Copays
and
Deductibles

Please come prepared to pay any copays or deductibles at the time of your appointment.

Referrals and Pre-Authorizations

Certain services and procedures may require a referral or pre-authorization. While we assist with ensuring your services are covered, it is your responsibility to confirm the terms of your insurance plan.

Workers Compensation

For patients whose injury is work related, you must provide the schedulers with all pertinent information such as insurance carrier, claim number, date of injury, adjustors name, phone and fax number before the appointment is scheduled.

Explanation of Benefits and Statements

At Vail-Summit Orthopaedics & Neurosurgery, we understand that navigating insurance can be confusing. In most cases, you will receive an Explanation of Benefits (EOB) from your insurance carrier. This document will generally outline what was billed, what was paid, and what we are able to bill you, the patient. EOBs can vary greatly depending on your insurance plan, and they often contain terminology that may not be familiar to you. If you ever have any questions regarding an EOB you've received, we encourage you to contact our business department at (866) 358-0202. We are here to assist you.

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You will also receive a statement for any unpaid balances on your account. Please note that any items still pending from the insurance company will not be reflected in your bill. Should you have questions about your statement, feel free to reach out to our business department for clarification.

Good Faith Estimate

If you do not have insurance or are choosing not to use it, you have the right to receive a Good Faith Estimate outlining the expected costs of your medical care. For more details, visit CMS.gov or call 1-800-985-3059.

Payment Plans

If you are uninsured or responsible for part of the payment, we request payment at the time of service. For those unable to pay at the time of service, please contact our business office in advance to discuss payment options (866) 358-0202.

Transparency in Healthcare Prices

Vail-Summit Orthopaedics & Neurosurgery complies with Senate Bill 17-065 by posting the most frequently billed codes. Pricing is an estimate, and actual costs depend on services rendered. For more information on payment options or self-pay discounts, please contact us before your visit.

Refunds

In the event that either you or your insurance company has overpaid on your account, we will process a refund in a timely manner. Refund checks will be issued to the appropriate payee based on the account’s payment history. If you have any questions about refunds, please don’t hesitate to contact us at (866) 358-0202.

 

For further assistance, contact our billing department at (866) 358-0202.

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