Insurance & Payment Information
At Romeo Orthopaedics, our goal is to provide highly specialized, personalized shoulder and elbow care with clear communication at every step. We understand that medical billing and insurance can feel confusing, especially when surgery may be involved.
Our team is here to help you understand your responsibilities, what may be covered by insurance, and what questions to ask before moving forward with care.
How Payment Works at Romeo Orthopaedics
Romeo Orthopaedics is an out-of-network practice for most insurance plans. This means we do not bill private insurance, Medicare, or Medicaid directly for Dr. Romeo’s physician services. However, depending on your insurance plan and the type of care you receive, some parts of your visit or surgery may still be covered by insurance. Full payment is due at the time of service unless prior arrangements have been made.
We will always do our best to provide clear cost estimates in advance so you can make informed decisions about your care.
Private Insurance Patients
Romeo Orthopaedics is out of network with private and commercial insurance plans. For office visits, procedures, and Dr. Romeo’s surgical fee, payment is made directly to our practice.
Although we do not bill your insurance directly, we provide an itemized superbill and detailed receipt with the billing codes your insurance company may need. You may submit this documentation to your insurance company for possible out-of-network reimbursement.
Out-of-network benefits vary by plan. Some patients receive partial reimbursement, while others may not. We recommend contacting your insurance company before your appointment or surgery to ask about your out-of-network benefits.
We strongly encourage you to contact your insurance company in advance to confirm:
- Whether the surgery center is in-network
- Whether anesthesia is covered
- What out-of-network benefits apply to the surgeon’s fee
Medicare and Medicaid Patients
Romeo Orthopaedics has opted out of Medicare and Medicaid for physician services. This means we do not accept Medicare or Medicaid assignment and do not bill these programs for Dr. Romeo’s care.
Medicare patients are required by law to sign a private contract before receiving care. This contract confirms that you understand you are paying Romeo Orthopaedics directly for physician services.
It is important to know that Medicare may still cover other parts of your care separately, such as the hospital, surgery center, anesthesia, external imaging, physical therapy, or other facility-based services. These services are billed by separate providers, not by Romeo Orthopaedics.
Workers’ Compensation Patients
Romeo Orthopaedics treats Illinois workers’ compensation patients and follows Illinois Workers’ Compensation Commission rules.
For approved workers’ compensation claims, we bill your employer or workers’ compensation insurer directly. You are not required to pay a copay, deductible, or out-of-pocket fee to Romeo Orthopaedics for approved workers’ compensation care.
If authorization is needed, our team will work through the appropriate approval process.
If You Need Surgery
Many patients are understandably concerned about the cost of surgery. We want to clarify that surgery billing usually involves several separate providers.
Dr. Romeo’s surgeon fee is paid directly to Romeo Orthopaedics and is considered out-of-network/self-pay.
However, other parts of your surgery may be covered by your insurance, depending on your plan and network. These may include:
- The surgery center or hospital
- Anesthesia services
- Imaging or testing
- Durable medical equipment
- Other facility-related services
These providers bill separately from Romeo Orthopaedics and may bill your insurance directly.
Before surgery, our team will provide an estimate for Dr. Romeo’s surgical fee. We also encourage you to contact your insurance company to confirm whether the surgery center, hospital, anesthesia team, and other providers are in network and covered under your plan.
For surgery, a deposit of at least 50% of Dr. Romeo’s physician fee is required before the procedure date. Our team will work with you to collect the remaining balance. Romeo Orthopaedics does offer CareCredit as an option to assist you with Dr. Romeo’s physician fees.
Superbills and Possible Reimbursement
As a courtesy, we provide documentation that may help you request reimbursement from your insurance company.
This may include:
- An itemized superbill
- CPT procedure codes
- ICD-10 diagnosis codes
- A detailed payment receipt
You may submit these documents to your insurance company for possible reimbursement. Any reimbursement is paid directly to you by your insurer.
Because every plan is different, Romeo Orthopaedics cannot guarantee reimbursement. Your insurance company determines whether any portion of your care is eligible for payment under your out-of-network benefits.
Questions to Ask Your Insurance Company
Before your appointment or surgery, you may want to ask your insurance company:
- Do I have out-of-network benefits?
- What percentage of out-of-network physician fees may be reimbursed?
- Do I need prior authorization for out-of-network care?
- Is the surgery center or hospital in network?
- Is the anesthesia group in network?
- Are facility fees covered?
- Are there deductibles or out-of-pocket maximums that apply?
- What documents do I need to submit a claim?
Our team can provide the superbill and receipt, but your insurance company is the best source for details about your specific benefits.
Self-Pay Patients
Patients without insurance, or those who choose to self-pay, are responsible for payment before care is provided.
We provide cost estimates in advance whenever possible. For outstanding balances, we offer clear explanations of charges and may be able to discuss flexible payment arrangements upon request. Romeo Orthopaedics offers CareCredit as an option to assist you with payment for your care.
Billing Questions
We know that billing can be stressful. Our goal is to make the process as transparent and manageable as possible.
Please contact our office if you have questions about:
- Appointment fees
- Surgery estimates
- Superbills
- Receipts
- Workers’ compensation billing
- Payment timing
- Outstanding balances
We value the trust our patients place in us and are committed to helping you understand your options before you receive care.
Important Note
Romeo Orthopaedics provides physician services only. Surgery centers, hospitals, anesthesiologists, imaging centers, laboratories, and other providers bill separately and set their own payment and insurance policies.
Coverage and reimbursement depend on your individual insurance plan. Please reach out to our team at . We’d be happy to discuss any questions or concerns.
Providing exceptional care for your shoulder or elbow is very important to Dr. Romeo. Please don’t let your out-of-network insurance discourage you from seeking his expertise.
Please reach out to our team at . We’d be happy to explain our practice set up; answer any questions you have and assist you with your shoulder or elbow care.
