Are Sports Medicine Specialists Covered By Insurance?

Are Sports Medicine Specialists Covered By Insurance?

Millions of people use a form health insurance to cover necessary medical expenses for both preventative and unexpected care. Each health insurance policy is different with various factors to consider when seeking treatment. As a participant in sports, the need for quality medical care from an orthopedic sports specialists may be needed to return to the game or activity with the shortest amount of recovery time.

Sports Medicine Specialists

sarahhammerHealth insurance coverage for a sports medicine specialist may require following specific guidelines as outlined in the policy. Speaking with the insurance representative or courteous medical staff will help determine what steps are necessary for successful coverage.


Under some insurance policy guidelines, a referral from the primary care physician is required prior to visiting a sports medicine specialist. The referral is to verify the need for a specialist is a medical necessity. Under most circumstances, the primary care physician is the one who suggests a specialist is needed for optimal care. The primary care physician may arrange the appointment as the next step in the treatment process. Without verification, medical insurance may not pick up the costs of the initial doctor’s consultation.


After the initial consultation is approved, further authorization may still be required for treatment. Most sports medicine specialist will have highly trained support staff to work with authorization requirements from insurance companies. Acquiring authorization will allow an athlete or sports participant to concentrate on the treatment program, including:

  • Physical or occupational therapy to help restore strength back to an injured area
  • Medical equipment, bracing, and other support aids to use during the healing process
  • Diagnostic tests to achieve an accurate diagnosis to outline a treatment program approach
  • Surgical procedures, joint replacement, open surgery or arthroscopy

The type of medical authorization needed for treatment will be different for each person. After a precise diagnosis, the treatment process may involve a combination of medical approaches to ensure the highest level of care.

Deductibles and Co-Pays

Along with the referral and authorization process, an insurance policy may require a patient to cover deductibles and co-pays. Calling the insurance provider’s customer service representative will provide an understanding of the amount of out of pocket expenses to expect when visiting a sports medicine specialist.

  • The deductible is a percentage amount of the medical expenses a patient is required to pay until a specific deductible is met
  • When a patient reaches the deductible, the medical insurance will pay the remaining amount
  • Co-pays are a flat rate to be paid by the patient for medical procedures, prescription, appointments, and other relatable expenses
  • Co-pays to a sports medicine specialist are usually low when other insurance guidelines are followed

Leading Sports Medicine Specialists

With a longstanding consistent practice, Dr. Howard Marans and his friendly staff understand all the various aspects relating to health insurance coverage. Dr. Howard Marans regularly works with numerous medical insurance carriers – including PPOs. The Doctor provides every patient with the highest level of treatment and care for a sports related injury without creating a burdening medical expense. Please click below to schedule your consultation or call us at 714.979.8981.