Living with Chronic Pain
Understanding Your Health Insurance Options
Prior to your physician appointment, contact your insurance provider to determine what pain treatment services are covered under your plan. If you do not currently have insurance, please use the Plan Finder provided by the federal government to assist you in finding a health insurance plan that best fits your needs and your budget.
Insurance coverage options are categorized as self-pay, Medicaid, Medicare, managed care/commercial insurance, or Worker’s Compensation coverage. Below are overviews of each category.
A office representative will gather a payment for services at the time of the patient's appointment unless a previous agreement has been made.
Medicaid cards should be shown to the office representative at the patient’s first appointment. The card must also be shown at the first appointment of each month.
Medicare is generally accepted for fees and treatments covered under Part B. For services not covered under Medicare, the patient is advised to check with their secondary insurance for coverage. For services not covered by either Medicare or secondary insurance, the self-pay category is applicable.
Managed Care/Commercial Insurance
Many insurance plans require a primary care physician’s referral prior to being seen by a pain management specialist. It is important to note that it is the patient’s responsibility to obtain this document and have it presented when in the pain clinic.
Workers Compensation Coverage
Prior to a patient scheduling an appointment with a pain management specialist, it is the patient’s responsibility to obtain authorization from the primary care physician. An exception to this is when the appointment with the specialist is only to acquire a “second opinion.” For second opinion appointment, the main evaluation will be covered. No additional diagnostic tests or services will be covered unless the patient’s primary care physician, or referring physician, has submitted a request to the Bureau of Workers Compensation.
If patients have questions regarding insurance coverage or workers compensation, they should contact their case manager and/or their insurance company. In addition, financial counseling can be a service that is offered to aid patients in the management of treatment costs.