OrthoVirginia Patient Center

Insurance and Billing

Attention patients that have seen Physicians at Advanced Orthopaedics: Insurance carriers may have notified you that your Advanced Orthopaedics provider is leaving the plan’s network.  Please note your coverage is now under that of OrthoVirginia and your Provider has not left the Insurance network. Your provider has the same relationship with your insurance as before, but under a different group name.  We are sorry for any confusion this may have caused.



We understand medical billing and health insurance can be extremely confusing. Therefore, OrthoVirginia is dedicated to providing you with as much education we possibly can to ensure your entire experience with us is nothing less than exceptional.

OrthoVirginia participates with most major insurance carriers. The list below depicts several of those carriers. Please keep in mind that OrthoVirginia provides specialty care in Central Virginia and Northern Virginia. Participation may be specific to region. In those cases, we have indicated “Richmond Only” or “North Only” or “Lynchburg Only”

COMMERCIAL PLANS

MEDICARE

MEDICAID
  • Aetna
  • Aetna Signature Plus (North Only)
  • Anthem PAR/PPO
  • Anthem Healthkeepers
  • Blue Cross Blue Shield
  • Carefirst (North Only)
  • Cigna
  • Coventry/First Health
  • Kaiser (North Only)
  • Mamsi – MDIPA
  • OneNet – Alliance
  • Optima Health
  • Optimum Choice
  • Piedmont Community Health Plan-PCHP (Lynchburg Only)
  • Tricare
  • United Healthcare
  • Virginia Health Network

Medicare (Traditional)

Medicare Advantage Plans:

  • Aetna Medicare Advantage 
  • Anthem Medicare Advantage
  • Healthkeepers CareMore
  • Humana Medicare 
  • Virginia Premier
  • United Medicare Advantage (not including AARP United Medicare Advantage)

Medicaid of Virginia

Medicaid HMO Plans:

  • Aetna Better Health of Virginia

  • Anthem Healthkeepers Plus
  • Optima Health Family Care
  • Virginia Premier

Click the hyperlink below for additional information on the following:

Workers’ Compensation

Policies

If you have any questions relative to participation or if you have any other questions regarding your coverage we encourage you to contact your insurance carrier directly and certainly before your visit. We would advise asking the following questions:

  1. Is OrthoVirginia a participating group and may I see a provider there in network?
  2. Please advise the details of my plan relative to co-payments, co-insurances, and/or deductibles.
  3. Is a referral required to see a provider at OrthoVirginia and if yes, am I responsible for initiating that process?

To better assist you, we have listed a few of the most frequently asked questions below. We understand you may have more specific concerns. That said we encourage you to contact us via the variety of methods below. We look forward to serving you.

Frequently Asked Questions

  1. If your insurance plan is not one OrthoVirginia participates with, please do not be discouraged. We will do our best to schedule an appointment for you. However, it is in your best interest to contact your insurance company to verify whether services provided will be covered.

    In these cases, carriers will often process your medical claims as “out of network,” which may result in a higher “out-of-pocket” expense to you. For benefit information, please call the member services telephone number located on the front or the back of your insurance card.

  2. We will schedule new patient appointments even if you do not have insurance. Further details will be disclosed regarding time of service payment requirements at the time you speak with a Call Center Agent.

  3. Your insurance company may require a referral in order for your treatment to be covered. Therefore, you should contact them prior to your visit. If you need a referral but 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.

    • Valid identification with photo ID
    • Insurance card(s)
    • Co-payment required by your insurance
    • Referral if required by your insurance
    • Copies of x-rays, MRI, and other test results, etc. that might be helpful in diagnosing and/or treating your condition
    • Either a current list of your over-the-counter and prescription medications, or your actual medication bottles
  4. Please go to the forms section for this information or click here.
  5. OrthoVirginia accepts cash, checks, money orders, and the following credit cards:

    • American Express (Central and Lynchburg Only)
    • Discover
    • MasterCard
    • Visa
    • CareCredit (Central Only)
  6. 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 obtain all benefits that are due you from your insurance company, and that you are able to satisfy your payment obligation to us.

  7. I received a statement in the mail that illustrates I had “surgery” even though I was never operated on. Is this a mistake?

    When billing an insurance company, physicians are required to identify the services rendered with codes from the “Current Procedural Terminology” (CPT) book.

    The CPT code set was designated by the Department of Health and Human Services 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 patient’s explanation of medical benefits mailed to them from the insurance carrier.

  8. What does global period mean?

    Any procedure classified as “Surgery” 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. This does not include additional x-rays or supplies received during the global period. In accordance with your insurance policy, these charges will be billed once you leave the office and, as a result, you may endure some financial responsibility.

    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, additional co-payments, deductibles and/or co-insurance do apply. Co-payments are required at the time of your therapy service.

  9. I have a question about the statement I received in the mail. Who should I contact and how?
    If you have questions about your bill, please do not hesitate to contact our business office.

    OrthoVirginia Central (Richmond)
    (804) 327-9242
    Business Hours: 8:00am – 5:00pm

    OrthoVirginia North (Fairfax)
    (703) 383-6469
    Business Hours: 8:30am – 4:30pm

    OrthoVirginia Lynchburg
    (434) 485-8545
    Business Hours: 8:00-5:00 pm

OrthoVirginia Central (Richmond)

(804) 327-9242
Business Hours: 8:00am – 5:00pm
billing@orthovirginia.com

OrthoVirginia North (Fairfax)

(703) 383-6469
Business Hours: 8:30am – 4:30pm

OrthoVirginia Lynchburg

(434) 485-8545
Business Hours: 8:00-5:00 pm