Paying for your care
How this works, in plain language.
Journey Orthopaedic Institute is out of network. That means something specific, and it is worth two minutes of your time before you book.
You pay the posted price at the time of your visit, whether or not your plan ever reimburses you.
If your plan has out-of-network benefits, we will help you file the claim, and any reimbursement goes to you, later, directly from your insurer. We think that is a good deal. We also think you should decide with the honest version in front of you rather than the hopeful one.
Being out of network is what lets us do the things you came here for. There is no prior authorization to wait on, no coverage decision standing between you and a diagnosis, and no separate facility bill arriving six weeks later. The price you see is the whole price, and you see it before you book.
What it does not mean is that we ignore your insurance. Where filing helps, we will do it for you.
Two situations, and they are not the same.
Most of what we do can generate an insurance claim even though we are out of network. Some of it cannot, at all, for anyone. We keep those separate because merging them is how people end up surprised.
01 · Most services
We are out of network
Clinic visits, physical therapy, imaging, procedures, surgery.
- You pay
- The posted price, up front, at the time of service.
- We help
- We provide out-of-network claims assistance. If your plan has out-of-network benefits, we hand you an itemized superbill and can file the claim for you.
- No promises
- There is no guarantee of reimbursement. Our estimator below can show you a range, using published Medicare rates as the reference, but it is an estimate and nothing more: your plan decides, and some insurers price against benchmarks they do not publish.
- Who gets paid
- You do, later, from your own insurer. Not us.
- Deductible
- It may count, but only if your plan has out-of-network benefits. Many HMO and EPO plans have none and credit nothing.
02 · Cash only
Services no insurance covers
Shockwave (StemWave), the Class IV laser, and orthobiologics: PRP, BMAC and MFAT.
- You pay
- The posted price, up front. It is the entire transaction.
- We help
- Nothing to file. No claim exists for these, for anyone, on any plan, so a superbill would not help you and we are not going to hand you one as though it might.
- Afterwards
- Nothing arrives in the post. That is the point of the number on the page.
Before you book
Check whether your plan has out-of-network benefits. It takes a minute, and it tells you whether a claim is worth filing at all. If it is, we give you an itemized superbill and can file the claim on your behalf.
You pay the posted price at the time of service whether or not your plan reimburses you, and reimbursement is not guaranteed. Any payment goes to you, directly from your insurer. Plans with no out-of-network benefits, which includes many HMO and EPO plans, credit nothing.
What might come back to you.
If your plan has out-of-network benefits, this gives you a range. You still pay the posted price up front, and nothing here is a guarantee.
Deductible not met yet
About $314 would credit toward the remainder of your out-of-network deductible. Note that it credits the allowed amount, not the $400 you pay.
You pay JOI, up front
$400
Collected in full at the time of service. This amount does not change, and it does not depend on what your insurer does.
Estimate only · possible reimbursement to you
$0
Paid by your insurer, to you, weeks later. We cannot guarantee it, and your plan may pay less than this or nothing at all.
- This is an estimate, not a quote. It is a planning aid, worked out from published Medicare rates because insurers do not publish their own.
- No guarantee of reimbursement. Your plan decides what it pays, and whether it pays anything.
- JOI fees are collected up front, in full, whether or not you are reimbursed.
How this is worked out
| Service | Charged | Medicare rate | Plan allows |
|---|---|---|---|
| New patient office visit99204 | $325 | $170 | $255 |
| X-ray, 3 views (included in visit)73562 | $75 | $40 | $59 |
A plan reimburses on its own allowed amount for each code, never on what you paid. Where the charge is lower than the allowed amount, the charge is used. Allowed amounts are modelled at 110% to 200% of the published Medicare rate for South Carolina, which is the range commercial plans commonly use. Your plan’s actual schedule is not public, which is why this is a range and not a number.
This is an estimate, not a quote, not a guarantee, and not your Good Faith Estimate. You pay the posted price at the time of service whether or not your plan reimburses you. Any payment goes to you, directly from your insurer.
Everything is paid up front.
01
In full, at the visit
Card, HSA or FSA where the service is eligible.
02
Our own payment plan
A deposit when you book, then three equal monthly payments. No interest and no fees, and that is not a promotion we can withdraw.
03
Third-party financing
Several options are available if you would rather spread it further. Terms come from the lender, not from us, and approval is theirs to give. Ask us and we will point you at the right one.
Things worth knowing.
- The estimator gives you a range, not a promise. Out-of-network reimbursement varies enormously between plans, and some insurers price against benchmarks they do not publish, so we show a range built from published Medicare rates rather than a single figure we cannot stand behind. Your plan decides what it pays.
- A deductible credit is only worth something if your plan has out-of-network benefits. Check your plan documents, or call the number on your card and ask that exact question.
- Surgery is quoted, not listed. Operations vary by what we find, so we give you a written estimate covering surgeon, facility and anaesthesia rather than a shelf price. Ask for a Good Faith Estimate and we will produce one.
- If you are on Medicare, tell us before you book. The rules there are different from everything above and your price may not be the price on the page. We will work it out with you directly rather than guess.
What we will not do
We will not tell you that insurance is a scam, because for many people it works. We will not promise you a reimbursement we do not control. We will not put an operation on sale, run a countdown on it, or tell you a surgical price expires Friday.
What we will do is put the number on the page and answer the question you actually came with.
Next step
Bring us the question. We will answer it straight.
Most new patients are seen the same week, in Fort Mill, at your home or gym in the mobile unit, or by video.