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VSON can help patients take a proactive approach to finding insurance options for treatment

The recent departure of Bright Health from the Summit County health insurance market has created another gap in services for both patients and insurance groups.

But with some of the best orthopedic surgeons in the world located at Vail-Summit Orthopedics & Neurosurgery’s facilities in Frisco, Colorado and operating out of the Dillion Surgery Center, it certainly makes sense for local patients to have access to those services and not have to travel to Metro Denver or traveling further afield for other alternatives. And with open enrollment now in the state, patients looking to maintain or secure access in the coming year are encouraged to do a lot of research to find a plan that will keep them in VSON’s care community.

Cari Thomason, VSON’s Director of Finance, says she works hard to try to offer options and education to patients who want localized access to surgery, sports medicine and more. But Thomason says patients should take an equally proactive approach to guaranteeing their existing coverage, rather than face any unexpected billing issues in the future.

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“Our goal as an orthopedic practice is to provide care to the community, and we do what we can to help patients
understand the local insurance market and get the best coverage they can.” – Amanda Leyrer

“Unfortunately, there just aren’t many local options, with only three insurers offering patients in-network coverage for our services on the individual market – Rocky Mountain Health Plans, which is part of the United Healthcare system, plus plans from Anthem Blue Cross Blue Shield and Cigna,” says Thomason. “Bright Health pulled out so quickly that many patients were left behind.”

Thomason says a big problem for patients is those people who split time between Denver and Summit County and believe — or hope — that their Front Range-based insurance coverage will automatically apply to VSON visits.

“It’s all completely different based on where you live, and based on primary residence,” she says. “If you live in Denver, that plan might not be accepted here in Summit County. We run into that a lot, especially with Anthem’s CU health plan or even Kaiser Permanente, when people have coverage without expanded networks.”

Thomason encourages patients to do their research – as frustrating as it can be to call health insurance companies or search through websites – to make sure their network will cover VSON services.

“As you plan your insurance choices, focus on what you believe your utilization may actually be and how much you expect to spend, and figure out the best plan for the care you plan to use,” says Thomason. “This is especially important if you have grown children who will go away from your insurance coverage as they approach the age of 26.”

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VSON helps patients to
easiest access possible to local
orthopedic services.

Amanda Leyrer, MS, ATC, OTC, SA, VSON’s Director of Clinical Operations, says VSON does its best to make sure local patients have the easiest access possible to local orthopedic services.

“Our goal as an orthopedic practice is to provide care to the community, and we do what we can to help patients understand the local insurance market and get the best coverage they can,” she says.

Leyrer agrees that patients are still in a challenging position as many of these insurance decisions are ultimately left up to them, with relatively little guidance available.

“It is especially difficult when insurance companies are not transparent to patients. So much of it comes down to knowing what questions to ask and always doing your own due diligence,” she says. “It’s important for people to have coverage that allows for acute care, especially with our active population. Take the time to understand your benefits.”

Leyrer suggests that potential patients with employer-sponsored insurance also pay close attention and keep those questions ready for HR staff during open enrollment season, a time when a candid conversation with a knowledgeable advocate can help ensure the right coverage—or unexpected avoid bills down the road.

“There are so many different variations of insurance out there, and they’re all trying to get a piece of the business, so you really need to know what you’re signing up for before you make that choice,” adds Leyrer.

Leyrer says some patients may also benefit from the discount provided by paying cash for services, but this also requires some foresight and may only be appropriate for some cases.

“We do offer self-pay cash discounts on a case-by-case basis, and there are benefits to that, but it depends on the procedure. It’s definitely another way to provide some relief.”

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