At Sohn Orthopaedics, we believe in delivering high-quality, personalized shoulder and arm care - whether or not we're contracted with your insurance company*. For patients with high-deductible plans, out-of-network benefits, or no insurance at all, we offer transparent direct-pay pricing and help you seek reimbursement from your insurance when possible.
Whether you're visiting from abroad, don't have coverage that fits your needs, or simply prefer more personalized and unrushed care, we offer an experience designed around you.
How Does Out-of-Network Billing Work?
We collect full payment at the time of service for all visits and procedures. If your insurance allows out-of-network billing, we will submit the claim on your behalf, including for clinic and procedure/surgery visits. If the insurance company reimburses us directly we will deposit and reissue a refund check to you.
If your insurer does not allow us to submit the claim, or if you prefer to submit it yourself, we will provide:
- A superbill (medical receipt with CPT and diagnosis codes)
- An itemized receipt for HSA/FSA or insurance reimbursement
Depending on your insurance:
- You may receive a check made payable directly to you.
- If your insurer sends payment to our office, we’ll cash it and mail you a refund check.
Do You Get Prior Authorizations for Surgery or Procedures?
Yes - when permitted by your insurance carrier, we will request prior authorization and submit claims on your behalf. When that’s not possible, we'll give you the documents you need to request authorization and submit claims yourself.
Please note:
- A prior authorization is not a guarantee of payment
- Reimbursement varies by plan. Some services may be partially covered, others denied
- Our assistance with billing does not make us financially responsible for what your insurance chooses to pay
Do You Still Take My Insurance?
Our practice has been actively negotiating with insurance companies to ensure fair rates that support the level of care we provide. Some plans remain in-network. Others do not.
Please call us to verify your insurance status before your appointment.
Even if we are out-of-network, many PPO plans offer partial reimbursement - especially for surgery related costs.
Flexible Payment Options
We accept:
- Major credit and debit cards
- HSA/FSA cards
- Personal checks
- CareCredit, a medical financing option that allows you to pay over time, often with low or no interest. This can be used for both clinic visits and surgical fees.
Clinic Visit Fees
(These rates include your exam and discussion. Imaging may be included at our discretion.)
- New Patient Consultation with Roger Sohn, MD: $310
- New Patient Consultation with Theresa Ho, PAC: $279
- Follow-Up Visit (MD or PAC): $253
We collect payment in full at or before your visit. If your insurance plan allows, we will submit a claim to your insurer on your behalf. Any reimbursement from your insurance will be sent directly to you or, if it is sent to our office, we will deposit it and promptly issue you a refund for the same amount.
If your plan does not allow us to bill for you - or if you prefer to submit your own claims - we'll provide superbills and itemized receipts to support your insurance or HSA/FSA reimbursement.
Surgical Fees
Our direct-pay fees include only the surgeon's professional fee. Exact prices will vary depending on complexity, but common bundled fees are listed here. (Surgeon's professional fee only - does NOT include charges from the surgery center, anesthesia group, or implant suppliers).
- Rotator Cuff Repair: $4,949 Includes biceps tenodesis and related debridement
- Shoulder Replacement: $6,282 Includes biceps tenodesis and joint 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
Even if we are out-of-network, many parts of your surgical care may still be covered by your insurance, including:
- Hospital or surgery center facility fees
- Anesthesia services
- Most implants and surgical supplies
- Intraoperative imaging
All surgical bundles include 90 days of follow-up care with Dr. Sohn (excluding splints, durable medical equipment, or imaging). Assistant fees are also included. If you're planning for surgery, you can call us for an estimate or to learn what's included in your care bundle.
Legal & Billing Transparency
We comply fully with the No Surprises Act, which means:
- We provide good-faith estimates before your visit or surgery
- We offer clear, upfront pricing
- We promptly supply receipts and billing documentation
Medi-Cal Patients*
Unfortunately, we do not participate in Medi-Cal. Under current regulations, we cannot accept cash payments from patients who are enrolled in Medi-Cal, even if they wish to pay out-of-pocket.
The only exception is for patients enrolled in reassigned Medi-Cal HMO plans, where we are contracted and reimbursed directly by the HMO.
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