Anthem Blue Cross PPO, Aetna PPO, Cigna PPO & Seoul Medical Group Insurance Changes – FAQs
A Notice to Our Patients
As part of an ongoing transition toward a more sustainable and patient-centered practice model, Sohn Orthopaedics will no longer participate in several commercial insurance networks during 2026.
The following changes are scheduled:
- Anthem Blue Cross PPO – Out of Network beginning June 1, 2026
- Aetna PPO – Out of Network beginning June 1, 2026
- Cigna PPO – Out of Network beginning August 1, 2026
- Seoul Medical Group – Out of Network beginning August 1, 2026
We understand that insurance changes can be confusing, and we want to reassure patients that we remain committed to providing exceptional shoulder and upper limb care throughout this transition. Here are some frequently asked questions and answers. We hope this will help to reduce uncertainty during these changes.
Can I Still See Dr. Sohn?
Yes.
Patients with Anthem Blue Cross PPO, Aetna PPO, Cigna PPO, and Seoul Medical Group plans are still welcome to receive care at Sohn Orthopaedics.
Depending on your specific insurance plan, you may have out-of-network benefits that can help offset a portion of your costs. Our team is happy to discuss your options and help you understand the process before your visit.
Why Is Sohn Orthopaedics Making These Changes?
Over the past several years, our practice has become increasingly focused on providing the highest level of shoulder and upper limb care possible. We believe excellent outcomes require more than surgery alone. Patients benefit from detailed evaluation, thoughtful treatment planning, education, accessibility, and close follow-up throughout recovery. Unfortunately, many modern insurance contracts have become increasingly rigid and administratively burdensome while failing to adequately support the time and resources required to provide this level of individualized care. Our transition out-of-network is intended to create a more sustainable model that allows us to maintain the quality, access, and patient experience that define our practice. This is part of a broader transition that is expected to continue through 2026.
What Does This Mean for My Visit?
If we are out of network with your plan:
Our team can provide documentation and itemized receipts for reimbursement when applicable.
Depending on your insurance plan, you may be eligible for partial reimbursement through your out-of-network benefits.
Patients are encouraged to contact their insurance carrier directly to learn more about their specific out-of-network coverage.
What Does This Mean for Surgery?
Dr. Sohn’s professional fee is separate from many other components of surgical care.
Even when Dr. Sohn is out of network, many aspects of your surgical episode may still be covered through in-network providers.
Whenever possible, we make every effort to use in-network hospitals, surgery centers, anesthesia providers, imaging facilities, and ancillary services to help minimize overall patient costs.
Many components of surgical care-including hospital or surgery center facility fees, anesthesia services, implants, imaging, and laboratory services-are billed separately by other providers.
Our team can discuss expected surgeon fees and provide an estimate of your patient responsibility amount before surgery.
What If I Established Care Before These Changes?
If you established care with Sohn Orthopaedics before your insurance plan became out of network, we are committed to helping you navigate the transition as smoothly as possible.
Because every patient’s situation is unique, questions regarding ongoing treatment, surgery scheduling, and follow-up care are reviewed individually by our team.
How Long Are Follow-Up Visits Included After Surgery?
For surgeries performed on an out-of-network basis, Dr. Sohn’s surgical fee includes routine postoperative follow-up visits for at least six months and often up to nine months after surgery.
If you are unsure whether your postoperative visits remain covered, please contact our office and we will gladly review your situation.
Where Can I Learn More About Direct Pay and Out-of-Network Care?
For additional information about our out-of-network process, patient responsibility amounts (PRA), reimbursement policies, and direct-pay services, please visit our Direct Pay & Out-of-Network Care page.
Questions?
Our team understands that insurance changes can raise questions, and we are happy to discuss your specific situation.
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