Insurance Info
Why We're Not In-Network
Health insurance, especially for orthopedic care, doesn't always work the way people assume. Before a surgery, an imaging study, or sometimes even a specialist visit can happen, many insurance plans require prior authorization, a separate approval process that can delay care by days or weeks.[1] In a 2023 survey, the vast majority of physicians reported that prior authorization delays treatment, and most said those delays cause patients to abandon care they actually needed.[2] For orthopedic surgery specifically, research has found that prior authorization doesn't reduce costs, but it does mean worse pain scores and longer waits before surgery.[3]
Being out-of-network removes that layer between you and your care. It doesn't mean your insurance is irrelevant, it means the insurance company isn't the one making decisions about your treatment.
The Concierge Financial Model
- If you have out-of-network benefits, your fee for the initial consultation is often waived entirely.
- If not, or on Medicare, a 45-minute new patient consultation requires a payment of $300.
- Costs for injections or surgery are always discussed transparently and in detail before you commit to anything.
- Many patients use HSA or FSA funds toward the cost of care, and your payment can often be submitted toward your out-of-network deductible.
This model is what allows us to spend real time with you, not rush through a visit to hit a volume target.
What This Actually Gets You
Because we're not bound to an insurance company's contracted terms, care isn't shaped by a coding schedule or a reimbursement quota. In practice, that means:
- Treatment plans built around you, not what a specific billing code allows
- Direct access to Dr. Thon, not a rotating provider pool
- Full transparency on cost, so you know what to expect before you commit to anything
- No surprise billing from denied claims or out-of-network surprises down the road
Our Commitment to You
- We won’t rush your visit.
- We won’t recommend surgery you don’t fully understand.
- We won’t push treatment you don’t need to grow our numbers.
- You’ll always see me on your initial visit.
Is This Right for You?
This model works especially well if you value time, direct access, and a plan built specifically around you, and are willing to invest in that. It may not be the right fit if cost is your primary deciding factor and you have strong in-network benefits you'd rather use elsewhere. We'd rather you know that upfront than be surprised by it later.
Frequently Asked Questions
Often, yes, at least partially. If you have out-of-network benefits, we can sometimes waive the fee for the initial consultation entirely. If you don't have out-of-network coverage, or you're on Medicare, a 45-minute new patient consultation requires a $300 payment, which can often be submitted toward your out-of-network deductible.
In most cases, yes. HSA and FSA funds can typically be used for out-of-network orthopedic visits, imaging, and surgery.
No. There's no recurring fee. You pay for the visits and treatment you choose, nothing more.
It might cost less than you think. Let's talk through it.
References
[1] Kaiser Family Foundation reports 99% of insured patients are subject to prior authorization rules for high-cost procedures.
[2] 2023 American Medical Association physician survey on prior authorization.
[3] AAOS 2025 Annual Meeting study on prior authorization and total hip arthroplasty outcomes.