Shoulder & Upper Limb Specialist – San Juan Capistrano
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 (OON) benefits, or no insurance at all, we offer clear upfront pricing and help you seek reimbursement from your insurance whenever possible.
We perform surgery at:
- Hoag Orthopedic Institute (Aliso Viejo)
- Laguna Niguel Surgery Center
- Mission Hospital
- Saddleback Hospital
These facilities are in-network with most insurance plans. That means your hospital or surgery center bill is usually processed at your highest benefit level, even if Dr. Sohn’s professional fees are billed out-of-network.
How Our Professional Fees Work
Our surgeon's fees are billed separately from facility, anesthesia, and implant charges. Before surgery, our team will:
- Verify your benefits
- Obtain prior authorization if required
- Provide you with a personalized estimate of your patient responsibility
Payment for the surgeon's fee is collected in full before surgery. After your insurance processes the claim, reimbursement may be issued directly to you or to our office.
Clinic Visit Fees
- 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
We collect payment in full at or before your visit. If your insurance allows, we’ll submit a claim on your behalf so you can be reimbursed directly. If your plan does not allow us to submit claims - or if you prefer to handle it yourself - we'll provide superbills and itemized receipts to support insurance or HSA/FSA reimbursement.
Surgical Fee Examples
These are typical patient responsibility amounts (examples only):
- Rotator Cuff Repair: $4,949 – includes biceps tenodesis & related debridement
- Shoulder Replacement: $6,350 – includes biceps tenodesis & joint capsule release
- Revision Shoulder Replacement: $7463– includes removal of old hardware
- Shoulder Instability Repair (non-Latarjet): $5,747 – includes remplissage if needed
- Latarjet or DAS Procedure: $5665 – includes remplissage if needed
- Elbow Ligament Reconstruction (Tommy John): $2,948
Disclaimer: These are common patient responsibility amounts, not our full billed charges. Actual billed amounts submitted to your insurance may be higher. Your individual out-of-pocket responsibility may vary based on your plan, benefits, and prior payments. Every patient receives a personalized written estimate before surgery.
How Insurance Payments Are Handled
Your Patient Responsibility Amount (PRA) is your maximum financial obligation to our office.
- You will never be billed above your PRA, even if your insurance company allows or reimburses a higher amount.
- If your insurance sends payment directly to you, that is yours to keep.
- If your insurance sends payment to us, we will process it according to our standard policy and issue any refund owed to you within 30 days.
This approach gives you clarity and peace of mind: your costs with our office are capped at the PRA, with no surprise bills later.
What May Still Be Covered In-Network
Even if Dr. Sohn’s fee is billed out-of-network, many parts of your surgical episode may still be billed in-network by other providers, such as:
- Hospital or surgery center facility fees
- Anesthesia services
- Most implants and surgical supplies
- Intraoperative imaging
We use in-network facilities whenever possible to help reduce your overall costs.
Included Follow-Up Care
- For out-of-network surgeries, your surgeon's fee includes all follow-up visits for at least 6 months (often longer, at our discretion). This is more than double the standard 90-day global follow-up included with most insurance claims.
- Note: Supplies such as imaging, splinting, or braces may still carry a fee.
Important Notes
- Prior authorization is not a guarantee of payment.
- Reimbursement varies by plan; some services may be partially covered, others denied.
- Our billing support is a goodwill effort - we'll help with claims and up to two appeals, but we are not financially responsible for what your insurance chooses to pay.
Flexible Payment Options
We accept:
- Major credit/debit cards
- HSA/FSA cards
- Personal checks
- CareCredit (low or no-interest financing for clinic visits and surgical fees)
Legal & Billing Transparency
We comply with the No Surprises Act by providing:
- Good-faith estimates before your visit or surgery
- Clear, upfront pricing
- Prompt receipts and billing documentation
Medi-Cal / CalOptima Patients*
We do not participate in Medi-Cal or CalOptima and cannot accept cash payments from patients enrolled in these programs, even if you wish to pay out-of-pocket. The only exception is for patients enrolled in reassigned Medi-Cal/CalOptima HMO plans, where we are contracted and reimbursed directly by the HMO.
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