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Insurance Information

General Insurance Information & Terms
Policies Accepted
Insurance Terminology & Definitions

IMPORTANT
It is the patient's responsibility to know the stipulations of their insurance policy, including referral & fee policies. Lake Pointe Orthopaedics is responsible for educating the patient of changes in their benefits or policy. We recommend that the patient verify coverage/benifits before their appointment, as well as insure proper referrals have been requested and sent to our office before their scheduled appointment. Thank You!

Insurance Companies offer a variety of insurance policies. Please click on plan name for more information:


Exclusive Provider Organization (EPO) - Form of managed care in which participants are reimbursed only for care received from affiliated providers.

Health Maintenance Organization (HMO) - A plan that offers a variety of services including physical exams, education, and preventative medicine programs, in exchange for a fixed-monthly premium. An HMO may be an independent company, or it may be sponsored by an employer, insurance company, hospital, union, or government agency. Members either select or are assigned a primary care physician who is responsible for all referrals in providing adequate patient care.

Indemnity Insurance - Insurance policies through which benefits are paid in a predetermined amount for a covered loss. Usually, the insured person receives services and submits a claim to the insurer, and providers are paid fees for the services rendered.

Independent Practice Association (IPA) - Plans that contract with individual practitioners who work at their own offices. Unlike salaried HMO staff, IPA physicians are allowed to treat patients from other health care plans, along with their own fee-for-service patients.

Major Medical Expense Insurance - A form of health insurance that provides benefits for most types of medical expenses (surgical, hospital) up to a high maximum benefit. Such contracts may contain internal limits and usually are subject to deductibles and co-insurance costs.

Managed Care (MC) - Systems that integrate the financing and delivery of appropriate health care services by means of arrangements with selected providers to furnish a comprehensive set of health-care services to members.

Point of Service (POs) - Plans tend to be more flexible than HMOs, but also require you to select a Primary Care Physician (PCP). Depending on insurance stipulations, the patient may choose to visit a doctor outside the network and still receive coverage — but the amount covered will be substantially less than if using a physician within the network. Some plans may require the patient to pay up-front and submit the claim for reimbursement.

Preferred Provider Organization (PPO) - A network of physicians and hospitals that provides an insurance company or employer with discounts for its services. Consumers covered by a PPO are allowed to use providers outside the PPO network, including specialists whenever they choose, for an additional expense.

Prepaid Group Practice Insurance - A plan under which specific health services are provided by participating physicians to an enrolled group of persons, with a fixed periodic payment made in advance by or on behalf of each person or family.

Specific Disease Insurance - Insurance providing a benefit, subject to a maximum amount, for expenses incurred in connection with the treatment of specified diseases, such as cancer. These policies are designed to supplement major medical policies.