Insurance Coverage of Hand and Upper Extremity Surgery

Medical insurance groups, such as United Healthcare and Anthem Blue Cross and Blue Shield, generally cover functional problems of the hand and upper extremity to varying degrees. Though aesthetic procedures or aesthetic portions of functional procedures are usually not covered, procedures for the treatment of hand and upper extremity problems, including hand pain, chronic wrist pain, trigger finger, carpal tunnel syndrome and tendon lacerations, are commonly covered by most health insurance policies. We also accept Worker's Compensation insurance.

What Does Medical Insurance Cover?

Your medical insurance policy is a contract between you and your insurance provider. Coverage for medical services and levels of payment depend on the terms of this contract. In contrast, the actual medical services and fees are an agreement between you and your hand surgeon. Therefore, you are responsible for any amounts, including deductibles and co-insurance, not covered by your insurance policy.

How Do You Begin the Insurance Process?

Following your consultation with Dr. Daniel Golshani, our Surgical Patient Coordinators and Insurance Specialists at Avosant Surgical Associates will contact your medical insurance carrier to verify your coverage, explain the nature of your hand or upper extremity problem and obtain authorization for the treatment and/or surgical procedure. Only functional claims for valid hand or upper extremity problems and surgery will be submitted. There are several specific actions you can take to help us expedite this process.

Please bring appropriate documentation with you including:

  • Current Insurance Card (Name & Phone Number of Insurance Group / Member ID Number)
  • Valid Driver's License or Picture ID
  • Pre-authorization or Letter of Referral from Primary Treating Physician

All patients under the age of 18 must be accompanied by a parent or legal guardian.

If the patient is hearing impaired or needs translation in some language other than English, Farsi or Spanish, please notify us in advance so that we may arrange for an interpreter.

It is important to remember that authorization by your insurance company does not guarantee payment of benefits. We strongly recommend that you also contact your insurance company to obtain information and better understand your coverage. As a courtesy, please make sure you give our staff complete up-to-date insurance information when you arrive for your first consultation and continue to update us of any changes to your insurance coverage. During your visit, we will ask you to sign a Disclosure of Information form, which will allow us to obtain your previous medical records.

What if Your Insurance Company Does Not Authorize Payment?

In some cases, your insurance company may not authorize payment for your hand treatment and /or surgery. They may also agree to pay a percentage of a claim. Therefore, you may choose to appeal the decision for another chance at coverage.

In appealing the decision, your first step should be to write a letter to your insurance company representative. In the letter, explain why your surgical procedure should be covered and ask that your request be reviewed by a board-certified hand surgeon. You may also want to request a full explanation of why coverage is being paid at a reduced level or denied.

How Can We Help?

Because the health insurance process can be complicated and difficult to understand, our experienced Insurance Specialists at Avosant Surgical Associates will work with you to make the process a more positive and easier experience. With your cooperation and help, we will assist you with the preparation of your insurance forms, claims and payment issues in order to efficiently use the time to concentrate on caring for your medical needs.

For more information regarding insurance for hand or upper extremity surgery, please contact one of our two locations in Los Angeles - Beverly Hills, (310) 274-3481. You can contact us via the Internet and fill out the online form provided.