A Notice to Our Patients with Health Net Insurance
Effective April 1, 2026
Dr. Sohn and his team will no longer be in-network with Health Net insurance plans as of April 1, 2026.
We remain happy to care for patients with Health Net coverage. However, beginning on this date, services provided by our practice will be out-of-network, and payment for Dr. Sohn’s professional services may be the patient’s responsibility, depending on the specific plan.
Health Net – Frequently Asked Questions
Q: Are you still seeing patients with Health Net insurance?
Yes. We are happy to continue seeing patients with Health Net coverage. However, as of April 1, 2026, we will no longer be in-network providers with Health Net plans.
Q: Will this increase my out-of-pocket costs?
Possibly. Because we will be out-of-network, some Health Net patients may be responsible for payment directly to our practice for clinic visits, procedures, and surgical services.
Coverage and reimbursement vary significantly by plan type. Some Health Net plans include out-of-network benefits, while others (such as certain HMO or EPO plans) do not. We strongly encourage you to contact Health Net directly to understand your specific benefits before proceeding with care.
Q: What does this mean for my visits and surgery?
Clinic Visits
- All clinic visits (new and follow-up) will be provided on an out-of-network or self-pay basis.
- Payment is collected in full at or before the time of your visit.
- When applicable, we will provide itemized receipts or superbills to support any reimbursement allowed by your plan.
Surgery
- Dr. Sohn’s professional (surgeon’s) fee is handled separately from hospital, surgery center, anesthesia, and other third-party charges.
- We collect the agreed-upon surgeon’s fee prior to surgery so there are no surprises.
- Prior authorization may still be required by Health Net for certain procedures but is not a guarantee of payment.
Q: What if I established care with you before this change?
If you established care with our practice before this change was announced, we are committed to helping you navigate the transition thoughtfully. Because insurance plans, timing, and clinical circumstances vary, any pricing considerations or accommodations will be reviewed on an individual basis, where appropriate.
Q: How long are follow-up visits included after surgery?
For surgeries performed on or after April 1, 2026, Dr. Sohn’s surgical fee includes all routine postoperative follow-up visits for at least 6 months, and often up to 9 months, at no additional charge.
If your surgery took place before April 1, 2026 (while we were still in-network with Health Net), we will continue to honor postoperative follow-up consistent with your surgical date and circumstances. If you are unsure whether your follow-up visits are still included, our team will gladly confirm this for you.
Q: What parts of my care might still be covered by Health Net?
Even though Dr. Sohn’s professional fee will be out-of-network, many components of your surgical care may still be billed separately and covered in-network, depending on your plan. These often include:
- Hospital or surgery center facility fees
- Anesthesia services
- Many implants and surgical supplies
- Intraoperative imaging
Whenever possible, we make every effort to use in-network hospitals, surgery centers, and anesthesia providers to help reduce your overall out-of-pocket costs.
Q: Does this change affect Health Net HMO plans?
No - this change does not affect Health Net HMO plans with which we currently participate.
If you are enrolled in a Health Net HMO plan where we are a participating provider (currently MCmg), you may continue to see us in-network and nothing changes.
If you are enrolled in a Health Net plan with which we do not participate, services provided by our practice will be considered out-of-network.
Q: Does this change affect patients with Medicare and Health Net secondary insurance?
In most cases, no.
If Medicare is your primary insurance and Health Net is your secondary insurance, we will continue to bill Medicare first. Any remaining balance will then be processed according to your Health Net secondary coverage and coordination-of-benefits rules.
Because secondary benefits vary by plan, reimbursement for the remaining balance is determined by Health Net, not by our practice. Our team is happy to help confirm your coverage before your visit or surgery.
Q: Will you bill Health Net for me?
Billing depends on your specific Health Net plan. Payment for Dr. Sohn’s professional services is collected at the time of care.
- For Health Net plans that allow out-of-network billing, we will submit claims when permitted.
- If your plan does not allow us to bill directly - or if you prefer - we will provide itemized receipts or superbills to support any reimbursement your plan may allow.
Q: How do I know if I’ll be reimbursed by Health Net?
Coverage and reimbursement vary by Health Net plan. We recommend calling the number on the back of your insurance card and asking:
- “Do I have out-of-network benefits for orthopedic care?”
- “If so, what is my reimbursement rate for office visits or surgery?”
- “Will reimbursement be sent directly to me, or to my provider?”
Our team is also happy to help you understand how these answers apply to your care.
Q: Why are you leaving the Health Net network?
We are making this change to improve the quality, consistency, and flexibility of care we provide.
Over time, we have found that certain insurance contracts impose rigid authorization rules and reimbursement structures that do not adjust for the time, complexity, and follow-up required for higher-quality, individualized care. While we continue to meet insurance requirements, these models often lack the flexibility needed to support the level of education, access, and longitudinal follow-up many patients value.
This decision reflects a broader transition in our practice toward a care model that prioritizes thoughtful evaluation, clear communication, and continuity - even when that level of care is not fully recognized or reimbursed by payors. Our long-term goal is to operate primarily out-of-network by the end of 2026.
Q: Where can I find more information about out-of-network and direct-pay care?
For a more detailed explanation of how out-of-network and direct-pay care works in our practice - including what to expect for visits and surgery - please refer to our Out-of-Network and Direct Pay webpage: https://www.sohnortho.com/direct-pay-and-out-of-network-care-shoulder-upper-limb-specialist-san-juan-capistrano/
Questions or Next Steps
We understand that insurance changes can be confusing. Our team is happy to review your specific situation and help you decide what makes the most sense for your care.
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