A Notice to Our Patients with UnitedHealthcare PPO Insurance
As of October 1, 2025, Dr. Sohn and his team will no longer be in-network with UnitedHealthcare PPO plans. We are still happy to care for patients with UnitedHealthcare PPO insurance and will help you seek reimbursement through your out-of-network benefits.
UnitedHealthcare PPO – Frequently Asked Questions
Q: Are you still seeing UnitedHealthcare PPO patients?
Yes. We are happy to continue seeing UnitedHealthcare PPO patients. However, as of October 1, 2025, all visits and surgeries are billed as out-of-network
Q: What does this mean for my visits and surgery?
- If reimbursement is sent to you: you keep it.
- If reimbursement is sent to us: we will refund you within 30 days for any portion that belongs to you (after discounts and outstanding balances).
Clinic Visits: Payment is due in full at or before your visit. If your plan allows, we will submit a claim on your behalf.
Surgery: We collect the full surgeon’s fee before your procedure. When permitted, we submit the claim to UnitedHealthcare.
- If reimbursement is sent to you: you keep it.
- If reimbursement is sent to us: we will refund you within 30 days for the portion that belongs to you (after discounts and outstanding balances). Our office retains any overage beyond what you paid.
Your total financial responsibility to our office ends with the amount you pay us up front for the surgeon’s fee. You may still receive separate bills from the hospital/surgery center, anesthesia, implant vendors, or imaging providers, as those are billed independently and usually processed in-network.
For more details, please visit our Direct Pay & Out-of-Network Care page:
https://www.sohnortho.com/direct-pay-and-out-of-network-care-shoulder-upper-limb-specialist-san-juan-capistrano/
Q: What if I recently had surgery while you were still in-network?
If you are still within your 90-day postoperative global period, we will continue to honor that period without charging for follow-up visits, even after our UHC contract ends. Supplies such as imaging, splints, or braces may still carry a fee.
Q: How long are my follow-up visits included after surgery?
For out-of-network surgical patients, your surgeon’s fee includes at least 6 months of follow-up visits (much longer than the standard 90 days most insurers allow). At our discretion, we may extend this to 9 months at no extra charge.
For in-network cases, the insurer’s standard 90-day global period applies.
Supplies such as imaging, splints, or braces may still carry a fee.
Q: What parts of my care might still be covered in-network by UHC?
Even though we are OON for the surgeon’s fee, many parts of your surgical episode are usually billed in-network, including:
- Hospital or surgery center facility fees
- Anesthesia services
- Most implants and surgical supplies
- Intraoperative imaging
Q: Does this change affect UnitedHealthcare HMO plans?
No. This change applies only to UnitedHealthcare PPO plans. If you have a UHC HMO plan where we are a participating provider, nothing changes - you are still in-network with us.
Q: Will you bill UnitedHealthcare for me?
Yes. When allowed by your plan, we will submit claims to UnitedHealthcare on your behalf. You pay our quoted rate up front.
- If UHC sends payment to you: you keep it.
- If UHC sends payment to us: we refund you within 30 days for the portion that belongs to you (minus discounts and outstanding balances). Our office keeps any overage beyond your payment.
Q: How do I know if I’ll be reimbursed?
We recommend calling the number on the back of your insurance card and asking:
- “What are my out-of-network benefits for orthopedic care?”
- “What is my out-of-network deductible, and how much have I met?”
- “What is my coinsurance rate for out-of-network services?”
- “Will reimbursement be sent directly to me or to the provider?”
Q: Why are you leaving the network?
Reimbursement rates from UnitedHealthcare PPO are not sustainable. Going out-of-network allows us to:
- Continue delivering excellent care
- Maintain transparent pricing
- Reduce administrative delays
- Include extended follow-up care that insurance usually won’t cover
Claim Form Resource:
If you prefer to submit claims yourself, you can use the UnitedHealthcare medical claim form:
https://member.uhc.com/myuhc/content/dam/myuhc/pdfs/claim-forms/CMS1500ClaimForm010402.pdf