Dr. Duany accepts most major insurance plans, including many commercial plans, Medicare, Medicaid, and others. The best way to confirm whether your specific plan is accepted is to contact our office directly before your appointment. Our team is happy to help verify your coverage and answer any questions you have about benefits, copays, or out-of-pocket costs so there are no surprises on the day of your visit.

Whether or not you need a referral to see Dr. Duany depends on your specific insurance plan. Some plans, particularly HMOs, require a referral before they will cover a specialist visit; others, such as PPOs, typically do not. If you are unsure whether your plan requires a referral, we recommend contacting your insurance provider or calling our office before scheduling your appointment.

These are three of the most common cost-sharing terms you will encounter when using health insurance:

• Copay: a fixed amount you pay for a covered service at the time of your visit, regardless of the total cost of the visit
• Deductible: the amount you must pay out of pocket each year before your insurance begins covering a share of your costs
• Coinsurance: your share of the costs of a covered service after you have met your deductible, expressed as a percentage; for example, if your coinsurance is 20%, you pay 20% of the covered cost and your insurance pays the remaining 80%

Understanding these terms can help you anticipate what your out-of-pocket costs may be for office visits, imaging, procedures, and surgery. Our team is happy to walk you through your benefits if you have questions.
 

Most major insurance plans cover orthopedic surgery when it is deemed medically necessary. Whether a procedure is covered, and how much you will owe out of pocket, depends on your specific plan, your deductible and coinsurance, and whether prior authorization is required. For elective procedures, your insurance may require documentation that conservative treatments have been attempted before approving surgical care. Dr. Duany's team will work with you and your insurance provider to help navigate the prior authorization process and ensure the appropriate documentation is in place.

Prior authorization is a requirement from some insurance plans that your provider obtain approval before performing certain procedures, ordering specific imaging, or prescribing certain treatments. It is intended to confirm that the recommended care meets the plan's criteria for medical necessity. Not all services require prior authorization, but more involved procedures such as MRI, gel injections, and surgery often do. Our office will handle the prior authorization process on your behalf and keep you informed throughout.

If you have questions about a bill you have received, please contact our billing office, and we will do our best to help clarify the charges. Explanation of benefits (EOB) documents from your insurance company can also help you understand what was billed, what was covered, and what you owe. Our billing team is committed to transparent, straightforward communication about costs and is always available to assist you in understanding your financial responsibility.