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Important Information


 

Insurance Questions

 

Insurance AnswersWhat is a preferred provider?

Most individual insurance companies are members of a large insurance group made up of multiple insurance companies.

A “preferred provider” is contracted with your insurance company or your insurance group. Your out-of-pocket expenses will typically be lower with a preferred provider.

 

Insurance AnswersIs North Idaho Orthopedics and Sports Medicine (NIOSM) a preferred provider for my insurance?

Because we participate with multiple groups, NIOSM is a Preferred Provider for most insurance plans.

We are a preferred provider for Medicare and Idaho Medicaid. You will know we are a preferred provider
if your insurance card has one of these symbols:

 

Blue Cross - Regence - IPN - First Choice Health - First Health / Coventry

 

Insurance AnswersIf you are NOT a preferred provider, will you accept my insurance?

Even if we are not a preferred provider, your insurance company may pay a portion of the cost. Only your insurance company can tell you what portion they will pay.

 


Blue Cross Hometown North

 

If you have Idaho Blue Cross insurance through the exchange , and your insurance card looks similar to the one below (Hometown North), Blue Cross requires you to select a primary care provider AND requires you to have a referral from that primary care provider before you schedule an appointment with our specialists at NIOSM.

HOMETOWN

If you do not have a referral from your primary care provider, Blue Cross considers your exam/treatment “Out of Network” and will not cover any portion of the appointment until you have met their ridiculously high deductible (see “Out-of-Network Deductible” example on the card). Ridiculousness of deductibles may vary.

What is a PCP?

A PCP is your Primary Care Provider (Physician). The name of your PCP appears on your insurance card. To have your appointment with one of our specialists at NIOSM, you’ll need a referral from your PCP.

What are Referrals?

Your insurance requires a process of informing the insurance company when you require care that your PCP is unable to provide (a specialist for example). In selected Blue Cross plans through the exchange, the patient cannot refer themselves to another provider. Contact Blue Cross for more information.

Referrals take 2 – 24 hours for in-network referrals, and 3 to 10 days for out-of-network referrals.

 

For more information from Blue Cross of Idaho, click here.

 

 


New Patient Paperwork

 

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