“Sports Medicine Cash-Pay Policy & Insurance Reimbursement Information

Notice of Cash-Pay Only Services

At North County Primary Care, we are committed to providing high-quality sports medicine care in a streamlined and transparent manner. To maintain flexibility in treatment options and avoid insurance-related restrictions, our practice operates on a cash-pay basis for all sports medicine services, including procedures such as platelet-rich plasma (PRP) injections, stem cell therapy, hyaluronic acid injections, musculoskeletal ultrasound, and other specialized treatments.

This means:

  • We do not bill insurance directly for sports medicine procedures.
  • Payment is required at the time of service.
  • We accept credit cards, debit cards, HSA/FSA payments, and cash.
  • Patients may submit claims to their insurance for potential reimbursement.

Insurance Reimbursement Process

Although we do not bill insurance directly, some patients may be eligible for partial reimbursement depending on their out-of-network benefits and insurance provider. We provide a Superbill, which includes all necessary details for you to submit a claim to your insurance company.

How to Submit a Superbill for Insurance Reimbursement

1. Obtain Your Superbill

After your appointment, we will provide a Superbill, an itemized statement that includes:

  • Your diagnosis code (ICD-10)
  • The procedure code (CPT code)
  • The total amount paid

2. Complete Your Insurance Company’s Claim Form

  • Most insurance companies require a claim submission form, which is available on their website.
  • Attach the Superbill to your claim form.

3. Submit the Claim

  • Send the completed claim form and Superbill to your insurance provider by mail, fax, or online portal (depending on your insurer’s submission process).

4. Insurance Processing & Reimbursement

  • Your insurance company will review the claim and determine reimbursement eligibility.
  • If approved, reimbursement will be sent directly to you based on your plan’s out-of-network coverage and deductible requirements.
  • If denied, you can appeal the decision by contacting your insurer and providing additional documentation if required.

Important Considerations

  • Coverage is not guaranteed. Reimbursement depends on your specific insurance plan and whether they cover out-of-network services.
  • Hyaluronic acid (HA) injections may be covered by some insurance plans for osteoarthritis, but prior authorization may be required.
  • PRP, stem cell therapy, and certain regenerative treatments are often considered elective and experimental by insurers and may not be reimbursed.
  • We do not participate in Medicare, Medicaid, or Tricare for these services.
  • Patients with HSA (Health Savings Account) or FSA (Flexible Spending Account) can often use these funds to pay for sports medicine procedures.

Questions?

We encourage patients to contact their insurance provider directly to ask about out-of-network reimbursement before scheduling an appointment. If you need assistance understanding your Superbill or claim submission, our office staff is happy to help!

Thank you for choosing us for your sports medicine care. We look forward to helping you stay active and injury-free!”