Resources
1. The Basics

Insurance

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  • In-Network

    ✅ Blue Shield of California

    ✅ Ontario Health Insurance Plan (OHIP)

    In-network plans have the most straightforward path. Our billing and insurance team will work with a patient's insurance plan ahead of a their scheduled surgery date to obtain prior authorization for the procedure.

  • Out-of-Network

    🟡 Aetna* (self-funded plans)

    🟡 Anthem Blue Cross

    🟡 Cigna

    🟡 United Healthcare

    🟡 All other commercial insurance plans not listed under "In-Network"

    With out-of-network plan, we will submit a request to the insurance company for prior authorization and a Single Case Agreement (SCA). If approved, the SCA provides coverage for patients seeking care outside of their network. Jun Surgical has had some success in pursuing this route on behalf of our patients. Due to timing sensitivity, this process begins 3 months prior to a scheduled surgery date.

    *We do work with self-funded (aka "employer-funded" or "self-insured" Aetna plans. See FAQ below for more details

  • We Do Not Work With

    ⛔️ Aetna*

    ⛔️ Medicare

    ⛔️ Out of state (non California) Medicaid

    ⛔️ Most HMO plans

    ⛔️ Tricare

    *Unless an insurance plan is self-funded by an employer (see FAQ below)

  • International or Uninsured

    Please inquire further with our office about your options.

FAQ

  • Our billing and insurance team will reach out to your insurance to submit for proper approvals starting 90 days out from your scheduled surgery date.

  • No, these are two different entities. If you have a "Blue Cross Blue Shield" policy, as many policies are, then the claims process of your specific plan may fall under Blue Shield of California (aka "Blue Shield") or Blue Cross. Our team can conduct an initial research once you have registered and have provided your insurance card.

  • Yes! 90 days from your scheduled surgery date, our team will reach out to your insurance plan to start the prior authorization and Single Case Agreement approval process. If approved, then you will have coverage for your procedure. If denied, then you may have the option to appeal the decision or pursue self-pay.

  • Yes! Consultations are available to anyone 18 years and older.

  • Our office does not automatically submit for prior authorization for a consultation. If you would like to submit a claim for your consultation, our billing and insurance would be happy to assist.

  • Our billing and insurance team can be reached at junsurgical@p3ths.com. Please note that you must be an established patient of Jun Surgical to inquire about personal insurance matters.

  • This type of plan is usually present in larger companies where the employer itself collects premiums from enrollees and takes on the responsibility of paying employees’ and dependents’ medical claims. These employers can contract for insurance services such as enrollment, claims processing, and provider networks with a third party administrator, or they can be self-administered. (source: healthcare.gov)

    If you are unsure as to whether your plan is self-funded, we recommend reaching out to your HR specialist. We may also be able to run a background check on your policy to determine this.

    Examples of companies with self-funded plans: Meta, Google, Starbucks

  • Absolutely! For patients who have already had a consultation, our team will be able to assist you in reading your insurance policy. Please send your insurance policy (usually a big PDF that you received at the start of your plan) to info@junsurgical.com for assistance.