Before Your Visit
- Notify our scheduling department at as soon as your coverage changes.
- Sometimes the same plan does not always mean the same coverage. Even though your plan may appear to be exactly the same as the prior year, your employer may have altered the level of benefits that are available to you. Contact your provider and review your plan at the start of a new plan year.
- Verify that your referral is current. Most HMO plans require a current referral from your primary care physician before they will cover any visits. Patients can request a new referral by communicating with the primary care physician’s office directly prior to an appointment.
- Make time allowances for obtaining authorization. Reauthorization is necessary at the start of the plan year even if the patient did not change insurance plans. Prior to a patient starting any diagnostic testing or treatment, their plans will require the providers of care to get referrals and authorizations.
The Rio Grande Valley Orthopedic Center participates with most major insurance carriers. Please consult your carrier or contact one of our scheduling representatives prior to your appointment to verify our participation status with your insurance plan. Our scheduling representatives can be reached at
After your appointment is scheduled, a representative from RGVO will contact your insurance company to verify eligibility, benefit type, co-payment amount, deductibles, and referral requirements. This is done 3-5 days prior to your appointment. We make every effort to obtain authorization for your visit, however, many insurance companies require the patient to acquire authorization from their primary care physician prior to the appointment. You must contact your primary care physician at least 3 days prior to your visit at RGVO to ensure they have forwarded your authorization. If you arrive for your appointment without authorization, we may be required to reschedule your appointment.
Our authorizations department handles authorizations for all tests requested by the physicians. These include MRI and EMG, among others. Each insurance company has its own rules regarding these outside services. Once your test has been scheduled, a representative from RGVO will contact the insurance company, the primary care physician, or the Worker’s Compensation Adjuster to obtain an authorization for it.
Once referred to Physical Therapy, our Therapy department contacts your insurance company as a courtesy to verify your insurance benefits. They will try to obtain information on insurance coverage, allowed visits, and patient responsibility amounts if any. They will also work to obtain authorization for Therapy in cases where authorization is required. It is always recommended that each patient call their insurance company as well, to confirm their benefits and any out of pocket expenses.
Durable Medical Equipment
Our DME Department provides patients with braces and supports as ordered by our physicians. Patients have a choice of where they receive these items. For convenience to our patients, they are offered at RGVO.
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