Shoulder surgery, Sports medicine, Shoulder replacement in West Palm Beach

Insurance

Coverage, referrals and estimates, explained before your visit.

Insurance

How billing works

Insurance can get confusing, especially when a shoulder problem needs more than one kind of care. Dr. Ryan Simovitch's practice in West Palm Beach, Florida focuses on shoulder surgery and sports medicine. He completed fellowship training in shoulder surgery through the Harvard Shoulder Service at Massachusetts General Hospital, then completed the Harvard Intercontinental Shoulder Fellowship at Uniklinik Balgrist in Zurich, Switzerland.

Because his practice covers everything from nonoperative options like PRP and Lipogems to arthroscopic rotator cuff repair, shoulder arthroscopy, and shoulder replacement, the coverage and costs tied to your visit depend on the specific care your shoulder needs. Insurance questions, including what your plan covers, whether a referral is required, and whether prior authorization applies, are answered by our office, not on this page.

Dr. Simovitch is accepting new patients. If you are unsure whether your insurance is accepted, call our office and our staff will check your benefits before your visit.

This page is for general information only and is not medical or insurance advice. Please contact our office directly to confirm your specific coverage.

Questions

Questions patients ask

Does insurance cover shoulder surgery?

Yes, in most cases. Major medical plans typically cover shoulder procedures when they are medically necessary, including the arthroscopic rotator cuff repairs and shoulder replacements Dr. Simovitch performs. The exact amount you pay, such as your copay or deductible, depends on your specific plan. Our office checks your benefits before any procedure is scheduled so there are no surprises.

Do I need a referral to see a shoulder specialist?

It depends on your plan. HMO plans usually require a referral from your primary care doctor before you can see an orthopedic surgeon, while PPO plans generally let you schedule directly. Many of the patients Dr. Simovitch sees for sports medicine and shoulder care arrive through a referral from another physician, and his office can coordinate directly with that referring doctor's staff to confirm what your plan requires.

Will my insurance require prior authorization?

Often, yes. Prior authorization means your insurance company reviews and approves a procedure before it happens, and it is common for larger shoulder operations such as total shoulder replacement or reverse total shoulder replacement. Smaller in-office treatments usually do not need this extra step. Our staff handles the prior authorization paperwork and will let you know before your surgery is confirmed if anything is pending.

Does insurance cover a second opinion?

Most plans do. A second opinion means having another orthopedic surgeon review your diagnosis and recommended treatment before you decide on surgery. Patients considering shoulder surgery sometimes seek a second opinion from Dr. Simovitch given his focus on shoulder and sports medicine care, and his office can tell you whether your plan requires anything specific to cover that visit.

What happens if a procedure isn't covered?

You still have options. If your insurance denies coverage or a procedure falls outside your plan's benefits, our office can discuss the denial reason, help with an appeal where appropriate, or walk through payment arrangements. This is handled case by case, since every insurance plan and every denial is different. This page is for general education and does not replace advice from your insurance carrier or our office about your specific plan.

Billing

How do payments work?

Contact the office to confirm insurance participation.

Ready to talk about your care?

Call the office or request an appointment. Accepting new patients.

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