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Navigating Insurance Changes in the New Year

Front desk insurance review

In this blog post, we'll explore key topics such as deductibles, out-of-pocket expenses, referrals, and procedure coverage to help you navigate the potential complexities associated with insurance changes in the new year.

Understanding Deductibles and Out-of-Pocket Expenses:

One of the essential aspects of your health insurance is the deductible. This is the amount you must pay out of pocket before your insurance starts covering the costs. At the beginning of the year, your deductible may reset, requiring you to meet it again. It's crucial to check your insurance policy for any changes to your deductible and understand how it might affect your financial responsibilities for orthopedic services.

Out-of-pocket expenses, including copayments and coinsurance, can also change with the new year. Take the time to review your policy and be aware of any adjustments in these costs, as they directly impact your overall healthcare expenses.

Referrals and Access to Orthopedic Services:

Some health insurance plans require a referral from your primary care doctor to see a specialist like an orthopedic physician. Changes in your insurance policy might affect these referral processes. Ensure that your primary care doctor is aware of any changes in your coverage and obtain the necessary referrals to avoid potential coverage issues for orthopedic consultations and treatments.

Impact on Regular Check-ups:

Regular check-ups are vital for managing orthopedic conditions and preventing potential complications. Insurance changes can impact your ability to schedule these routine appointments. Stay proactive by confirming your coverage for preventive services and scheduling necessary check-ups before any policy adjustments take effect.

Procedure Coverage:

Insurance changes can also influence the types of procedures covered during your orthopedic visits. It's crucial to be aware of any alterations to your coverage that may affect the reimbursement for specific treatments or surgical procedures. Discuss these changes with your orthopedic provider to understand how they may impact your treatment plan and associated costs.

Patient Responsibility:

Orthopedic practices often deal with a multitude of health care plans, making it challenging to keep patients informed about individual insurance changes. Therefore, it becomes the responsibility of the patient to stay informed about their coverage and be proactive in addressing any potential issues. This awareness is especially important during the winter months, as snowy and icy conditions can increase the likelihood of falls and accidents, necessitating prompt medical attention.


As we enter the new year, take the time to review your health insurance policy and understand any changes that may impact your orthopedic care. Being proactive in managing your coverage can help you avoid unexpected out-of-pocket expenses and ensure that you receive the necessary care during the busy winter months. Stay informed, stay proactive, and prioritize your orthopedic health this winter.

Orthopaedic Surgical Consultants PC

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