At Sohn Orthopaedics, we deliver high-quality, personalized shoulder and arm care - whether or not we’re contracted with your insurance.* For patients with high-deductible plans, out-of-network (OON) benefits, or no insurance, we offer transparent pricing and will help you seek reimbursement from your insurer whenever possible.
Where We Operate
We perform surgery at Hoag Orthopedic Institute (Aliso Viejo), Laguna Niguel Surgery Center, Mission Hospital, and Saddleback Hospital - facilities that are in-network with most insurance plans. This means your hospital or surgery center bill is usually processed at your highest benefit level, even if Dr. Sohn’s professional fees are billed OON.
How the Surgeon’s Fee Works
Our professional (surgeon) fees are billed separately from facility and anesthesia charges. Before surgery we will:
- Verify your benefits
- Obtain prior authorization if required
- Explain the full billed amount we submit to insurance and the direct-pay amount you owe our office
Payment for the surgeon’s fee is collected in full before surgery.
If You Don’t Use OON Benefits
If your plan does not offer OON benefits - or you prefer not to use insurance - we provide transparent direct-pay pricing for most procedures.
Clinic Visit Fees
(These rates include your exam and discussion. Imaging may be included at our discretion; we will inform you if additional imaging charges apply.)
- New Patient Consultation with Roger Sohn, MD: $310
- New Patient Consultation with Theresa Ho, PA-C: $279
- Follow-Up Visit (MD or PA-C): $253
Payment is due at or before your visit. If your plan allows, we can submit a claim on your behalf. If not - or if you prefer - we’ll provide a superbill and itemized receipt for insurance or HSA/FSA reimbursement.
Surgical Fees
(Surgeon’s professional fee only - does not include charges from the surgery center/hospital, anesthesia group, implant vendors, or imaging.)
Our direct-pay fees cover only the surgeon’s fee. The figures below are examples, not quotes. Actual billed amounts may vary by diagnosis, complexity, and intra-operative findings. Insurance EOBs often show higher “billed charges” than your quoted rate because we are required to bill our full fee schedule. Your personal responsibility to our office is limited to the rate we quote and collect from you.
- Rotator Cuff Repair - $4,949 (includes biceps tenodesis & related debridement)
- Shoulder Replacement - $6,282 (includes biceps tenodesis & capsule release)
- Revision Shoulder Replacement - $8,423 (includes removal of old hardware)
- Shoulder Instability Repair (non-Latarjet) - $5,747 (includes remplissage if needed)
- Latarjet or DAS Procedure - $6,711 (includes remplissage if needed)
- Elbow Ligament Reconstruction (Tommy John) - $2,948
Please request a personalized written quote for your specific procedure.
What Might Still Be Covered In-Network
Even if we are OON for the surgeon’s fee, many parts of your surgical episode are usually billed in-network by other providers:
- Hospital or surgery center facility fees
- Anesthesia services
- Most implants and surgical supplies
- Intra-operative imaging
We use in-network facilities whenever possible to help lower your overall costs.
Refunds & Reconciliation (applies to clinic and surgery)
After your insurance processes the claim:
- If payment is sent to our office: We will issue a refund within 30 days for any portion that belongs to you (based on the insurance payment we receive), minus any discounts applied and minus any outstanding balances on your account.
- If payment is sent directly to you: You keep it. You will not receive an additional bill from us for amounts paid directly to you by insurance.
Bottom line: your total financial responsibility to our office ends with the amount you pay us up front for the surgeon’s fee - you will not receive additional bills from us later.
You may still receive separate bills from the hospital/surgery center, anesthesia, implant vendors, or imaging providers, as those are billed independently and typically processed in-network.
How the OON Process Works
- Verify Benefits & Authorization - We confirm OON benefits and obtain prior auth if required.
- Collect Surgeon’s Fee - You pay the agreed direct-pay amount before your procedure.
- Submit the Claim - We submit our full surgeon’s fee to your insurer (when permitted).
- Refunds & Reconciliation - Handled per the policy above.
- If We Cannot Bill for You - We provide a superbill (with CPT & diagnosis codes) and an itemized receipt for your insurance or HSA/FSA.
Included Follow-Up Care (OON Patients Only)
For OON surgical patients, your surgeon’s fee includes all follow-up visits for at least 6 months after your procedure (longer than the standard 90 days most insurers allow). At our discretion, we may extend included follow-up to 9 months at no additional charge.
Supplies such as imaging, splints, or braces may carry a separate fee.
For in-network cases, the standard 90-day post-op follow-up period applies.
Important Notes
- Prior authorization is not a guarantee of payment.
- Reimbursement policies vary by plan; some services may be partially covered or denied.
- Our help with billing is a courtesy; we cannot guarantee insurance payment decisions.
- Once you pay our quoted rate, you will not receive further bills from our office for that episode of care.
Flexible Payment Options
We accept: major credit/debit cards • HSA/FSA cards • personal checks • CareCredit (low/no-interest medical financing for clinic and surgical fees).
Legal & Billing Transparency
We comply with the No Surprises Act by providing: good-faith estimates before care, clear upfront pricing, and prompt receipts/documentation.
Medi-Cal / CalOptima Patients*
We do not participate in Medi-Cal/CalOptima and cannot treat those plans on a cash-pay basis due to state regulations. The only exception is for patients in reassigned Medi-Cal/CalOptima HMO plans where we are contracted and reimbursed by the HMO.
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