Participating Insurance Plans

OrthoVirginia participates with the insurance companies below.  We may not participate in every product or plan offered by your insurance company. To avoid confusion or out-of-network costs, we encourage you to check with your insurance company before scheduling an appointment. To check with your insurance company, you can call the member services line on the back of your insurance card.

Government Plans

  • Medicare
  • Medicare Railroad
  • Medicaid of Virginia
  • Tricare/Humana Military

Medicare Advantage Plans

  • Aetna
  • Anthem CareMore
  • Anthem Healthkeepers MediBlue
  • Anthem MediBlue 
  • Anthem NYC Retiree Health Alliance
  • Clear Spring Health
  • Humana
  • Kaiser Permanente Senior Advantage
  • Molina Complete Care
  • Optima Health
  • United Healthcare
  • Virginia Premier

Medicaid of Virginia HMOs

  • Aetna Better Health (*CCC)
  • Anthem Healthkeepers Plus (*CCC)
  • Humana Gold Plus
  • Molina Complete Care
  • Optima Family Care (*CCC)
  • Virginia Premier (*CCC)

*CCC:  Medicaid Commonwealth Coordinated Care Plus Plans

Commercial Health Plans

  • Accountable Care Management Group (ACMG)
  • Aetna
  • Anthem (PAR/PPO/FEP)
  • Anthem Healthkeepers (HMO)
  • Carefirst
  • Cigna
  • Cigna Connect
  • Custom Ink
  • Kaiser Permanente (Northern Virginia area only)
  • MedCost/Virginia Health Network
  • Optima Health
  • Oscar (Virginia Plans, HCA Hospitals, Richmond area only)
  • Piedmont Community Health Plan (Lynchburg and Southwest Virginia areas only)
  • Prime Health
  • SaveATree
  • United Healthcare

Financial Policy

We accept most insurance plans and will file insurance claims on your behalf. Ultimately you are responsible for the balance of your account. We ask that you pay your copays, deductibles, and co-insurance required by your insurance at the time of your appointment.

If you have an outstanding balance due, we appreciate you paying all of it now. If you are unable to pay all of it now, please ask about arranging a payment plan. If many attempts to collect payment from you are unsuccessful, we may turn the outstanding balance over to a collection agency. As well the principal balance due, you will also be responsible for any legal or collection agency fees.

Any time a check is returned for insufficient funds you will be charged a $50 fee.

  • Assignment of Benefits: I authorize direct payment from my insurance plan to OrthoVirginia. I understand that it is my responsibility to provide accurate insurance information and to secure all necessary prior approvals, authorizations, and referrals as required by my contract with my insurance company.
  • Third Party Payments: I understand that OrthoVirginia will not hold my account open during any period of litigation or negotiation that I may have with a third party such as an auto policy and may pursue collection action against me during that period.
  • Medicare: I request payment of authorized Medicare benefits for all services provided by OrthoVirginia. I authorize any holder of medical or other information about me to release to Medicare and its agents any information needed to determine these benefits or benefits for related services.
  • Cancellation Policies: We can charge a fee for canceling an appointment less than 24 hours in advance. We can charge a fee for not showing up to an appointment.
  • Right to Choose Your Facility: OrthoVirginia is a physician owned practice. Our physicians also own outpatient surgery centers, MRI facilities, and physical therapy clinics associated with OrthoVirginia. Because our physicians own these services, they are best able to ensure that the highest level of care is provided to you. You can ask that services be provided at locations other than those owned by OrthoVirginia.

If you have any questions about your insurance coverage please contact your insurance carrier directly before your appointment. We suggest asking the following questions.

  1. Is OrthoVirginia a participating group? Do OrthoVirginia providers count as in-network?
  2. What are the co-pays, co-insurances, and/or deductibles for my plan?
  3. Is a referral required to see a provider at OrthoVirginia? If it is, am I responsible for starting that process?

Some frequently asked questions are below, but please call us at 866-706-7876 if you have more specific questions.

Notice of consumer rights (PDF)

Frequently Asked Questions

Q: May I schedule an appointment even if OrthoVirginia does not participate with my insurance?
A: Yes, even if OrthoVirginia does not participate in your insurance, we can schedule an appointment for you. You will want to contact your insurance company to see if the services that OrthoVirginia provides will be covered.

When you go to an office that does not participate in your insurance, your insurance company will usually process your medical claim as out of network, which may cause higher out-of-pocket expenses for you and cost more. For specific information, please call the member services telephone number on your insurance card.

Q: I do not have insurance. Can I still make an appointment?
A: Yes, we will schedule new patient appointments even if you do not have insurance. When you make the appointment with our call center, the person you talk to will give you more details about the payment requirements.

Q: Will I need a referral in order to be seen and receive medical treatment?
A: Your insurance company may require a referral in order for your treatment to be covered by insurance. OrthoVirginia does not require a referral for you to be seen. You should contact your insurance company before your appointment with OrthoVirginia to see if your insurance company requires a referral.  If your insurance company says you need a referral but you 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.

Q: I was involved in an automobile accident. How does OrthoVirginia handle the billing for that?
A: If you have been in an auto accident, you will need to file a claim with your car insurance company. We will not file with car insurance. However, if your health insurance should be filed for an auto accident, please take the extra step to contact your insurance company for verification and then contact our billing department.

OrthoVirginia Centralized Business office
Monday-Friday 8 a.m. – 5 p.m.

Q: I have insurance. How do I know what I will have to pay for a visit or procedure?
A: 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 get all benefits your insurance company owes you and that you are able to pay your OrthoVirginia bills.

Q: My insurance information has changed. Who should I notify and how?
A: Please call the business office to tell us any changes to your insurance information, phone number, mailing address, or email address. You can also call the main line for the region you live in and they can direct you.

OrthoVirginia Centralized Business office
Monday-Friday 8 a.m. – 5 p.m.

Q: I received a statement in the mail that says I had “surgery” even though I was never operated on. Is this a mistake?
A: Short answer: No, if you had another procedure.

Long answer: When sending a bill to an insurance company, physicians are required to identify the services that a patient received using codes from the “Current Procedural Terminology” (CPT) book.

The U.S. Department of Health and Human services decided on the CPT code set 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 explanation of medical benefits that your insurance company sends to you.

Q: What does global period mean?
A: Any procedure classified as “Surgery” using the CPT book (see question above) 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. Additional x-rays or supplies that you receive during the global period are in a separate category from the visits. You may be billed and have to pay for the x-rays or supplies depending on your insurance plan.

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

Q: I have a question about the statement I received in the mail. Who should I contact and how?
A: If you have questions about your bill, please contact our business office at the phone number below or via MyChart

Monday-Friday 8 a.m. – 5 p.m.