Orthopedic surgery in Paramus

Insurance

Coverage, referrals and estimates, explained before your visit.

Insurance

How billing works

Insurance coverage for orthopedic care varies by plan and by procedure. Dr. Michael Ast's office in Paramus verifies benefits individually for each patient, whether you arrive through a physician referral or contact the practice directly, before any sports medicine evaluation or joint replacement procedure.

Patients come to Dr. Ast for a range of reasons, from sports medicine evaluations to planning for partial or total knee replacement or total hip replacement. Because the reason for a visit affects what an insurance plan will cover, our team checks your benefits for each visit rather than applying one blanket policy to every patient.

Dr. Ast trained in orthopedic surgery at North Shore-LIJ Health System and completed fellowship training in Adult Reconstruction and Joint Replacement surgery at Hospital for Special Surgery. That fellowship is the training behind the joint replacement procedures offered at this practice, including computer-assisted and robotic-assisted partial and total knee replacement, robotic-assisted total hip replacement, and minimally invasive hip and knee replacement. Some insurers ask for extra documentation or prior authorization before approving procedures that use this kind of technology, and our staff handles that paperwork directly with your insurance company.

Many patients reach Dr. Ast through a referral from another physician. Whether you were referred or contacted the practice on your own, the insurance process is the same: bring your insurance card and a photo ID to your first visit, and a member of our team will confirm your in-network status and explain what your plan covers before you proceed with any procedure.

We do not list procedure prices on this website, because what you owe depends on your specific plan and benefits. The most accurate answer comes from a direct benefits check with your insurer, which our office completes before surgery is scheduled.

Dr. Ast is accepting new patients at this Paramus location.

This page is for general information and does not replace a conversation with your insurance company or a member of our billing staff about your specific coverage.

Questions

Questions patients ask

Does Dr. Ast accept my insurance plan?

Most major insurance plans are accepted at Michael Ast's Paramus, NJ practice, though specific network status changes from year to year and plan to plan. Dr. Ast is currently accepting new patients, and the office verifies network participation for your specific plan before your first visit; call the office directly with your insurance card in hand to confirm.

Will my insurance cover knee or hip replacement surgery?

In most cases, yes. Total and partial knee replacement, hip replacement, and other joint reconstruction procedures are typically covered by major medical insurance and Medicare when a surgeon documents medical necessity, according to the American Academy of Orthopaedic Surgeons (2024). Michael Ast completed fellowship training in adult reconstruction and joint replacement surgery at Hospital for Special Surgery, and that training shapes how the medical necessity of a procedure, whether a primary, complex, or revision total joint replacement, is documented and submitted to your insurer.

What if my insurance requires prior authorization before surgery?

Prior authorization is common, not unusual. Most insurers require documented imaging, a record of prior non-surgical treatment, and a surgeon's clinical notes before approving a knee or hip replacement, and the practice's staff prepares and submits that documentation on your behalf once surgery is scheduled. Authorization timelines vary by insurer, so confirm the expected turnaround with the office when your procedure date is set.

Does Medicare cover joint replacement?

Yes, in most cases. Medicare Part A and Part B cover medically necessary hip and knee replacement, including the hospital stay, surgeon's services, and approved rehabilitation, according to the Centers for Medicare & Medicaid Services (2024). Supplemental or Medicare Advantage plans may add their own authorization steps, so bring your Medicare card and any secondary coverage information to your first visit.

Do I need a referral to see Dr. Ast?

No, a referral is not required to schedule an evaluation. Many patients arrive this way regardless: referrals commonly come from primary care physicians and sports medicine specialists managing patients whose knee or hip pain has not resolved with non-surgical care. Some insurance plans, particularly HMO plans, require a referral on file for the visit to be covered, so check with your insurer and bring any referral paperwork your plan requires. This information is educational and does not guarantee coverage. Confirm your specific benefits with your insurance carrier and the practice before scheduling.

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.

Request an appointment (201) 599-8056