Please see the listing below of insurance plans that we accept. Please bring your insurance card with you. It is very important for you to bring your current insurance card each visit and to inform us if there has been any change in your coverage or in your address. As changes may occur in the plans that we accept, please verify our acceptance at the time you make an appointment. The list below is not exhaustive, there are many smaller group plans, and out of state plans that we are also affiliated with. Even though your insurance may not be shown on the list, you may call (480) 994-1149 to see if we participate with your insurance plan. We are in the process of resigning from many HMO type plans, and certain PPO plans which Dr. Kozinn feels are beginning to present obstacles and challenges to providing good care. Very often, you will have out-of-network benefits available on your PPO plan that may be applicable in our office. You can ask Gerry in our office to call your insurance plan to see what your out-of-network benefits are. Often they are better than you may expect, but may have a separate “deductible” to meet.
As of April 1, 2014, Dr. Kozinn has opted-out from Medicare. He is not a “Participating Provider” for Medicare. This means he is NOT able to be reimbursed directly from the Medicare program. However, Dr. Kozinn can and wants to treat Medicare patients that can and are willing to work with him outside the program. (You should know that your Medicare will pay for all hospitalization costs, as well as for tests and rehabilitation. Other medical providers including the anesthesiologist can still be paid by Medicare. Our patients will have the opportunity to discuss their surgical fee directly with the doctor. More complex surgeries ( ie: revisions, post-trauma deformities, congenital abnormalities, and higher risk more difficult cases, will generally have a higher surgical fee than a more routine primary joint replacement). Our receptionist, or Gerry our office manager, will be happy to speak to you and explain more about what that means. We really do like to see Medicare patients, but we must negotiate our fee directly with our patients, as we are no longer able to bill Medicare as a participating provider. We will both sign a piece of paper called the “Medicare Private Contract”, which outlines the terms for obtaining care outside of the provider program There are many changes in healthcare coming in the post ObamaCare world. We are being proactive and making some changes so that we can continue to provide the best care for our patients.
WE are making changes in our insurance plans: Please call 480 994 1149 for the latest updates. As of April 1 2014, We are also NO LONGER on Humana health plan, but we can work with your out-of-network Humana PPO Benefits. We are no longer an Aetna provider as of June 10, 2015, but again, we are happy to work with your out of network benefits. We have resigned from United Health Care and our last day as an in-network provider is December 1, 2015. Most United Healthcare patients DO HAVE out of network benefits available for use in our office. If you were a prior health plan patient who is in follow-up period from surgery, we will accept any insurance companies “transition of care” rates during the plans allowed follow-up period. We are no longer Cigna in-network providers as of September 9, 2015. Many patients will have out of network benefits that they can use. Dr Kozinn will always be available to advise prior patients about the best plan for long term follow-up. We do associate with other orthopedic surgeons on the health plans and on Medicare that will see you if you wish to stay with an “in network” provider. We will remain on Blue Cross PPO plans for the forseeable future, and continue to be on Healthnet PPO, at this time. We do accept many work related injuries and industrial compensation patients. However, we will try to get pre-authorization from the industrial carriers BEFORE scheduling an appointment.
Scottsdale Joint Center will make every effort to verify your coverage prior to your appointment, yet we cannot guarantee coverage of services by your insurance company. You may need to pay a co-pay or a larger amount towards you total bill at the time of service if we can not verify the full extent of your coverage. We no longer have have X-ray capability in the office, as many patients do bring their own x-rays taken at outside facilities. Please bring the CD disc with your X-rays/MRI/CTT scans on it. We always appreciate hard copies when possible ( on old fashioned plastic XRAY film) of your x-ray studies , as they are much easier to show to patients in the exam room. Dr. Kozinn likes to draw diagrams and point out abnormalities on the printed films. (He also plans out his surgeries on the actual hard copy Xray film…that is still difficult to accomplish online!) Most patients requiring new Xrays will get them across the hall at the unafilliated SMIL radiology office in our building. Generally this is done to save patients money, as SMIL is a participating provider for Medicare and all common insurance plans. They will negotiate a “cash price” for Xrays if you are from outside the United States, or with no US health insurance.
Self Pay Patients
If you are a self-pay patient, new Medicare patient, or if we are not able to verify your insurance at the time of registration, we will require a minimum fee of $250.00 for new patients towards your anticipated services (office visit and Xrays taken in the office ) in advance at the time of registration. Additional fees may be assessed at the time of check-out. Additional Xrays and unplanned joint injections can be more costly. Prior established Medicare patients who wish to re-visit the office will generally pay a fee of $150 for their visit. This fee may increase if Xrays or injections are done in our office. We do accept credit cards at the time of service. ( We accept Visa, MasterCard, and Discover card. We do not accept American Express cards.)
New Medicare Patients:
Dr. Kozinn opted out from Medicare on April 1, 2014. This means Medicare and all of its secondary insurances will not pay Dr. Kozinn for his services. Dr. Kozinn does WANT to treat you if you are on Medicare, but we will have to negotiate a cash price for his services outside of the Medicare system . Medicare allows us to do that! If you are a new medicare patient there will be a $250 charge for your initial evaluation. If you choose to have xrays done in the office, they will cost $50 per film printed. If you wish to get your X-rays done at an outside facility ( We do have a SMIL X-ray center in our building that will accept your Medicare as payment) that is fine, and we will send you there with a prescription for your Xrays if you prefer. We can give you a prescription to get the films needed at SMIL at the time of your appointment or call it in before you arrive at the office. This may take an xtra 30-45 minutes to walk across the hall for Xrays, so plan your visit time appropriately. If you are a prior patient of our office and now on Medicare, our fee is generally $150 excluding Xrays and/or injections. If these rules are confusing to you, or you have further questions about our Medicare policies, please call the office and ask for Gerry. We are doing our best to give you VIP care, and Gerry ( our surgery scheduler and in office manager) can explain all of the rules and issues in detail to you.Call her at 480 994 1149.
Benefits and eligibility
While we will assist you to make sure that you have met the requirements for payment by your insurance. However, you are ultimately responsible for payment of all services that are not covered by your insurance plan. Sometimes it is impossible for us to verify benefits at the time of service, and you may have to pay for part or all of your bill at the time of service. We will re-imburse any amounts your insurance company eventually pays towards that bill.
Accepted insurance plans include:
We accept insurance plans including: All BlueCross/Blue Shield Plans, most Industrial / worker’s compensation plans ( with authorization from the insurance carrier!). We have resigned from Aetna, United Healthcare, Humana and Cigna plans. We are presently evaluating whether to remain on some other plans, but we are currently still providers for BC and HealthNet PPO. We do not see the Healthnet SeniorCare plans. Since we are no longer a Medicare provider, we are unable to see patients with any of the HMO Senior Plans (which are “Medicare Advantage” plans that replace Medicare) without special authorization. Since we are not medicare providers, we are unable to see Cigna, UHC, BC, HlthNet, and Aetna Senior plan members unless the patient obtains “special authorization” from the carrier.
If your insurance is not listed please call our office at (480) 994-1149 to see if we are contracted with your insurance plan. Ask for Gerry to discuss Medicare issues or insurance plan questions.