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se-ortho-team

Southeast Orthopedic Specialists Accepted Insurance List

Insurance Companies which SOS is a participating Provider. If the patient’s Insurance plan is not listed as one we participate in, they are encouraged to contact their Carrier and request that SOS be added.

Accepted Insurances (Updated: 02/18/16)

  1. AARP Medicare Complete, AARP Advantage, AARP WellMed HMO
  2. Aetna
    a. PPO
    b. HMO (MUST HAVE AUTH #)
    c. EPO
    d. Axcel
    e. Aetna Medicare
    f. Choice II plans
    g. Assurant (LIMITED BENEFIT PLAN)
    h. Select (MUST HAVE AUTH #)
    I. Metitain Health
  3. Alignment Healthcare (Medicare replacement plan) (PCP will get 1st auth and then up to SOS to get auth for SX & PT)
  4. Auto – Patients must have health insurance as a backup option – We must be participating with the plan
  5. AvMed
  6. BeechStreet
  7. Blue Cross Blue Shield (Florida Blue) All BC claims go to our local PO Box 1798 – even out of state
    a. PPO (aka Traditional, PPS/PPC)
    b. Advantage 65 (Medicare supplement plan)
    c. HMO (Health options/Blue care) (MUST HAVE AUTH # FOR OV PROCEDURES ONLY)
    d. Network Blue (Blue options)
    e. BCBS Medicare PPO (only PPO, not HMO)
    f. Blue Freedom Medicare
    g. Anthem
    h. BCBS Medicare Preferred HMO (MUST SAY ALIGNMENT HEALTHCARE ON INSURANCE CARD)
    i. BCBS Gator Care, Par with Prime Plus, Premium, Healthy Rewards and Options
  8. CareFirst
  9. Cigna
    a. PPO
    b. HMO (MUST HAVE PAPER REFERRAL)
    c. Open Access Plus (OAP)
  10. Coventry
    a. Summit (MUST HAVE PAPER REFERRAL)
    b. Carelink (MUST HAVE PAPER REFERRAL)
    c. Silver (MUST HAVE PAPER REFERRAL)
    d. National
    e. Medicare Advantage HMO (MUST HAVE PAPER REFERRAL)
  11. First Health
  12. Golden Rule
    a. United Healthcare Navigate Plus (MUST HAVE AUTH #)
    b. UHC Choice Plus Network
  13. Great West
  14. Healthsmart
  15. Humana Commercial
    a. PPO
    b. EPO
    c. POS
    d. HMO/HMO Premiere (MUST HAVE AUTH #)
    e. Traditional Plans
    f. Open Access
  16. Humana Medicare
    a. PPO
    b. HMO (MUST HAVE AUTH #)
    c. Regions PPO
    d. Gold (Classic & Plus) (MUST HAVE AUTH #)
    e. Care Plus (MUST HAVE AUTH # FOR THE SPECIFIC PROVIDER AND BODY PART)
  17. Mail Handlers Benefit Plan
  18. Medicare part B
  19. MultiPlan
    a. Freedom Life Ins Co (LIMITED BENEFIT PLAN)
  20. Pre-Existing Condition Insurance Plan (PCIP)
  21. Private Health Care Systems (PHCS)
  22. Railroad Medicare
  23. Smart Health
    a. Mission Hills (St. Vincent Employee Health Ins. Effective 01/01/15)
  24. Tricare
    a. Standard & For Life
    b. Reserves
    c. Champ VA
    d. Prime (MUST HAVE AUTH #)
    e. Veteran’s Association (MUST HAVE AUTH # AND FOR SPECIFIC PROVIDER AND BODY PART)
    f. Veteran’s Association Choice (MUST HAVE AUTH # FOR SPECIFIC PROVIDER, BODY PART AND OV LOCATION)
  25. Tufts
  26. United Healthcare (UHC) AARP Medicare Complete, HMO, Dual Complete
    a. United Healthcare Compass (MUST HAVE AUTH #)
    b. United Healthcare Core (MUST HAVE AUTH #)
    c. United Healthcare Navigate Plus (MUST HAVE AUTH #)
    d. United Healthcare Choice Plus HMO
    e. Wellmed Medicare HMO (MUST HAVE AUTH #)
    f. Wellmed Medicare PPO
    g. Secure Horizons
    h. UMR
  27. Worker’s Compensation(Injury must be current and not recently treated by another surgeon)
    We take several; most common are:
    a. Broadspire
    b. Amerisys – City of Jax
    c. John Eastern
    d. Vocational Rehab
    e. Sedgwick
    f. Amerisure
    g. Zenith
    h. AIG/Chartis
    i. US Dept of Labor

 

Out of Network – Accepted for all insurers, as long as they have Out-of-Net Coverage

Please Notify Patient: PAYMENT WILL BE EXPECTED AT TIME OF SERVICE

  1. Gator Care/Gator Blue PPO – (20% to 40% co-insurance for Tier 2 plans)
  2. Mail Handlers (out of network coverage only, if they don’t use the First Health network)
  3. Mayo (out of network coverage only)

 

Plans Not Accepted

  1. Medicaid – ALL PLANS
    a. Molina Health
    b. Healthease
    c. Access Health
    d. Sunshine State Health
    e. Wellcare
    f. Medipass
    g. Healthy Kids
    h. Staywell
    i. Medicaid Share-cost
  2. Aetna SRC (hospital indemnity plan – LIMITED BENEFIT PLAN)
  3. BCBS Gator Care EPO we are non par. (EPO Prime is printed on card)
  4. BCBS Go Blue
  5. BCBS Blue Select
  6. BCBS Medicare HMO – patients can only go to Shands
  7. Carrington (LIMITED BENEFIT PLAN)
  8. Coventry – Medicare Advantage PPO, Medicaid plans and Healthy Kids
  9. Evercare (Medicare Replacement Plan)
  10. GHI
  11. Medcom
  12. Starbridge
  13. UHC Community Plan (MEDICAID ONLY PLAN) – The ID # will be identified as (00000-000000000-00)
    (UHC Medicaid and UHC FL Healthy Kids)
    (UHC Rivervalley ID number will start with PD)
  14. United American
  15. Wellcare Medicare

 

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John Redmond, MD

Joint Replacement & Hip Preservation Specialist

Southeast Orthopedic Specialist is proud to introduce the newest member to our team, Dr. John Redmond. Dr. Redmond is a graduate of the University of Minnesota Medical School. He then completed his residency in Orthopedic Surgery at Mayo Clinic...

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