Pre Authorization

At Edmonds Orthopedic Center, our team of expert surgery schedulers and billing office representatives use their years of experience to make sure your path to surgery is as smooth as possible. Unfortunately, the challenges presented by insurance companies are constantly changing, sometimes without notice to us. We promise to do our best to keep you informed with the most up-to-date information we have available.

Before your scheduled date for surgery, one of the surgery schedulers from Edmonds Orthopedic Center will contact your insurance company and verify your insurance benefits. They will also obtain any necessary authorization required by your insurance company.

We will not move forward with your surgery unless it’s approved (authorized) by your insurance company. Though we do our due diligence and work hard to obtain prior authorization, your insurance company maintains that prior authorization is still not a guarantee of payment. Ultimately, according to your insurance company, it is the patient’s responsibility to make sure any surgery is a covered service with your insurance plan.

We will notify you if there are any issues with your insurance company that may cause a delay getting your surgery scheduled.

Next, after receiving the benefit information from the surgery scheduler, a representative from our billing office will contact you to let you know the estimated out of pocket cost for your surgery (this includes BOTH the professional fee for your surgeon and the facility fee for the ambulatory surgery center).

If there is a patient responsibility associated with your plan (co-payment or deductible owing), a pre-payment will be required at the time of service.  It is always a good idea to contact your insurance plan to learn what surgical benefits are available to you so that you are aware of your deductible and yearly out-of-pocket responsibilities when the billing representative contacts you.