Orthopaedic Sports Medicine at Cypress
ORTHOPAEDIC SURGEONS DEEPLY ROOTED IN THE COMMUNITY
Billing Department - Financial Policies
We would like to thank you for choosing Orthopaedic & Sports Medicine at Cypress, LLC (OSMC) as your medical provider. To keep you informed of our current office and financial policies we ask that you read and sign our Billing Policy prior to any treatment.

Canceled Appointments: If you are unable to keep your scheduled appointment, please contact our office at least 24 hours prior to your appointment to reschedule your appointment.

No Insurance: Payment will be due at the time of service. If you are unable to pay your balance in full, you will need to make prior arrangements with our Financial Counselor.

Insurance: Please bring your insurance card with you at the time of your appointment. For insurance plans that we contract with, your carrier requires that all co-pays be paid prior to any services being rendered. The co-pay requirement cannot be waived by our practice, as it is a contractual agreement by your insurance carrier. If you do not have your co-pay at the time of your visit, we will ask you to sign a document that states that you are financially responsible for the bill.

You are responsible for any co-insurance, deductibles or non-covered services as required by your insurance. You will receive a statement from our office indicating what your insurance has paid. Any remaining balance is due upon receipt of that statement

If you have any questions about your statement, please call toll free 1-800-573-2833 ext. 8806.



High Deductible Health Plans: High Deductible Health Plans (HDHPтАЩs) are consumer-driven health plans that have a minimum deductible and out of pocket limit that is set on an annual basis. If you have a HDHP, OSMC will schedule a time for you to visit with our financial counselor to receive a cost of care estimate in order to help you budget for your share of any of the following out of pocket expenses such as your deductible, co-insurance, co-pay and/or any non-covered service.

Payment Plan: For your convenience, OSMC offers our patients the flexibility to put down a deposit and make payments on large out of pocket expenses, relating to deductibles, co-insurance, co-pays and/or any non-covered services.

If you have questions about your payment plan, please call our Financial Counselor at 316-219-4758 ext. 211.


HMO or POS: For any POS and HMO insurance plans that we are contracted with, you are required to obtain a referral from your Primary Care Physician (PCP) before receiving services. Please bring that referral with you or have it faxed to our office at 316-219-5899. Any services received without a referral or proper authorization will be your responsibility.

Auto Accident Injury: If your injury is due to an automobile accident, we request that you provide us with any information that will assist us in getting your medical claims paid. If your services are due to and/or are payable by a third party, OSMC reserves the right to treat the third party as the primary payor. This information may include:
  • a  claim number
  • a claim mailing address
  • adjusterтАЩs name and phone number
  • medical insurance
Payment for any services that we provide will ultimately be your responsibility if not paid promptly by another party.

Liability Injury: If your injury is a result of another partyтАЩs negligence, we request that you provide us with any information that will assist us in obtaining reimbursement for the services rendered to you. If your services are due to and/or are payable by a third party, OSMC reserves the right to treat the third party as the primary payor. This information may include:
  • a  claim number
  • a claim mailing address
  • adjusterтАЩs name and phone number
  • medical insurance
Payment for any services that we provide will ultimately be your responsibility if not paid promptly by another party.

Workers' Compensation: If your injury is due to an accident in your work place, please be sure to contact our office as we will need to review records prior to scheduling any appointment.  If you have any questions, please call 316-219-4758 ext. 205.

Return Checks/Rejected ACH Withdrawals: A $30.00 charge will be added to your account for any checks returned or ACH withdrawals rejected by your bank for any reason in addition to any fees that your financial institution may charge you.

Disability or Insurance Forms: There will be a charge of $25.00 for the completion of medical forms. Payment is due at the time that you drop off the forms. Please allow 7 - 10 days for the completion of these forms.

Medical Records: We will provide you a copy of your medical records upon request. You will need to sign a letter of release.  Medical Records Release Form. Please allow 30 days for us to copy your records. If your records are for personal use, there will be a fee.  If records are for continuing medical care and sent to another provider, there is no charge.  Rates charged are within Kansas State Statutes.

X-Rays: We will provide you a copy of your X-Rays upon request. You will need to sign a letter of release. Medical Records Release Form. Please allow 48 hours from the time of your request. There is a $5.00 charge per disc, that is payable at the time of pick up. If you have any questions or concerns, please contact our X-Ray Department at 316-219-4758 ext.217.

Fracture Care: Fracture Care is billed out as a "packaged" service which includes the following: Evaluation, the first cast or splint application and 90 days of postoperative follow-up care from the date of the fracture. There are some services that we bill separately which include: x-rays, all casting supplies, replacement cast applications, evaluations for any additional problems or injuries and treatment of complications. Your insurance carrier requires that we report our services using the coding system known as the Current Procedural Terminology (CPT). The codes for fracture care can be found in the Surgery section of the CPT book. This is not to imply that you will have or had surgery or that you will be or were taken to the operating room. This is how the CPT book was set up by the American Medical Association (AMA) for user-friendly purposes by both the insurance companies and physicians. Please note, your insurance company may cover these services for fracture care differently than office visits. Therefore, your services may be paid as a surgical procedure, with deductible and co-insurance guidelines applied.

If you have questions about our Financial Policies, please call our Financial Counselor at 316-219-4758 ext. 211.

Thank you for allowing us to service you!


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