What Insurance Do We Take?
At Pain Solutions, we understand the importance of personalized care for all our patients. Many of our patients find self-pay to be a better option, as they are unrestrained by insurance. We also work with a few insurance providers to help you access the pain management services you need. Below is an overview of the insurance plans we accept and information on filing claims for out-of-network benefits.
Insurance Plans We Accept
We are contracted with most Presbyterian Commercial and Senior Care plans. As in-network providers for Presbyterian Commercial Plans and Presbyterian Senior or Medicare Advantage Plans, we can offer you the benefits of these plans, including coverage for pain management treatments and procedures.
However, please note that we are a non-participating provider with Medicare. This means we do accept Medicare insurance but are not bound by the Medicare-approved payment rates. As a non-participating provider, we do not accept Medicare assignment, and the patient may be responsible for paying up to 30% coinsurance instead of the typical 20% for Medicare-approved services.
Self-Pay Patients:
We welcome self-pay patients at Pain Solutions. Our standard fee schedule for self-pay patients is available on our website. We believe in transparency and strive to offer fair and reasonable prices for our services.
Please note: We cannot accept any medicaid plans, including medicaid plans under Presbyterian.
Out-of-Network Benefits:
If your insurance plan includes out-of-network benefits, you can still receive reimbursement for your visits to our clinic. Out-of-network benefits permit you to get reimbursed when you seek services from providers who are not contracted with your insurance company. While we may not be contracted with your insurance provider, you can submit a claim with your insurance and receive reimbursement for the allowable amount for your visit.
Important Considerations
The amount your insurance will reimburse for out-of-network services may vary based on your specific insurance plan.
Even with out-of-network benefits, there may be a deductible and coinsurance amount that you are responsible for paying.
Filing a Claim for Out-of-Network Benefits:
Filing a claim for reimbursement with your insurance company is generally straightforward. Most insurance providers have online portals where you can fill out a claim form. The form typically requires the CPT codes (procedure codes) and ICD-10 codes (diagnosis codes) for the services you received. You can find these codes in your patient portal under the visit note or by contacting our clinic directly.
Additionally, you may need Dr. Nairn's NPI number (National Provider Identifier) and his tax ID for the claim. Our office can provide you with this information upon request. Alternatively, you can request an itemized bill from us for your visit, which will include all the necessary codes.
Questions? Contact Us!
If you have any questions about insurance coverage, our services, or how to file a claim, please feel free to call us at (505) 247-9700. We are dedicated to providing compassionate care and personalized pain management solutions to help you find relief and improve your overall well-being.
Get Informed and Take Charge
At Pain Solutions, we believe in empowering our patients with information to make informed decisions about their healthcare. Understanding your insurance coverage, benefits, and potential out-of-pocket costs is crucial to avoid surprises and manage medical expenses effectively.
We encourage you to contact your insurance provider to verify your benefits, including out-of-network benefits, prior to scheduling an appointment with us. Our team is here to assist you and answer any questions you may have regarding insurance coverage, reimbursement, and payment options.
