Frequently Asked Questions

In a time where many patients suffering from chronic pain are trying to learn more about their symptoms and self-diagnose on the internet, we educate our patients on everything from conditions and symptoms, to what to expect at their appointments and offer full transparency on what our patients are saying about us.

FAQ

Explore the categories below to find the information you need.

Yes.

Pain is mediated by several factors, including the brain and the nervous system. The hardware of the brain and nervous system changes with chronic pain, stress, and trauma. Mindfulness-Based Cognitive Therapy has demonstrated its ability to repair and restore this hardware. Dr. Milspaw teaches that we must “update the hardware in order to update the software.” If our intention is to change the habit of pain within the nervous system, we must first heal the hardware of our brain. As you learn and practice these brain exercises, you train the brain to heal these painful habits. More information about pain and the mind-body connection can be found below.

MBCT can help change the thoughts, emotions, beliefs, reactions, and behaviors related to pain. By improving your coping strategies we help shift your brain's perception and reaction to incoming stimuli. Pain causes a stress response which can amplify pain sensations via chemicals in the brain. MBCT can help reduce the stress response and thereby allow the body’s natural pain relief mechanisms to be more powerful.

Mindfulness-Based Cognitive Therapy (MBCT) combines the practices of Mindfulness-Based Stress Reduction (MBSR) techniques with Cognitive Behavioral Therapy techniques. Mindfulness is the practice of being in the present moment without judgment and without trying to change anything. It is the practice of experiencing what some call “the beginner’s mind” as if we were experiencing something with wonder and awe for the first time. It is the practice of being the observer of our experience. Mindfulness is a “being” state of mind rather than a “doing” state of mind. Often, we focus on the past (what we should/could/would have done differently) or we focus on the future (what might happen). MBSR techniques help guide us to focus on the present moment. Through the practice of being in the moment, one can both quiet the mind and calm the body. MBSR works to relax the body through a variety of different exercises, including breathing work. As we breathe, we relax the mind by redirecting conscious awareness.

MBSR is ideal for cultivating greater awareness of the unity of mind and body, understanding how our conscious and unconscious thoughts, feelings, and behaviors can undermine emotional, physical, and spiritual health, and increasing levels of acceptance and compassion in our lives. The benefits of MBSR address a variety of health problems. The mind is an important factor in chronic pain and other stress and stress-related disorders. Scientific research establishes that MBSR positively affects a range of autonomic physiological processes involved in reducing chronic pain, such as lowering blood pressure and reducing overall physical and emotional arousal and reactivity. Mindfulness is a lifetime engagement – helping all of us counter the inevitable dissociation that we all tend to develop as a protective mechanism against pain and other types of trauma.

MBCT utilizes the effect of MBSR to bring the client into the present moment and gain awareness of the thoughts and beliefs they are experiencing in reaction to their mental, emotional, and physical state. As we become capable of observing our emotions, thoughts, and sensations, we increase our ability to change our focus and thereby change our brain and nervous system’s response to our experience. As we change our focus, we change our experience of pain. As we change our experience of pain, the brain and nervous system relax and have an opportunity to heal more effectively and efficiently.

MBCT tends to be a short-term therapy modality. The goal is to provide you with the skills and experiences you need to manage and heal your pain within 12-16 weeks. Your treatment duration depends on many variables, including your individual needs for more in-depth trauma work and support. We use a 3-month mark as a reassessment point when we review your goals and commitment to the therapeutic process.

No. When someone is referred to see a psychologist or counselor for behavioral health treatment, a common misperception is that the clinician is claiming the pain is “only in their head”. This is not our belief. It is important to understand that the pain you experience is 100% real. It is also important to understand that your brain mediates the perception of pain, and therefore, your thoughts, beliefs, past experiences, and brain health are all involved in your experience of pain.

There are several steps you can take to prepare for a successful telehealth counseling session. The more you prepare for your session, the higher the probability of success.

Step 1: Find a place that is comfortable, private, and distraction-free.
Step 2: If possible, try to be the only one on your Wi-Fi and close out other internet tabs on your computer.
Step 3: Inform those at your location that you will be having a confidential meeting to help decrease the likelihood of being interrupted.
Step 4: Turn notifications off on your phone, tablet, and/or computer.
Step 5: Set intentions for your session. When we set intentions, we increase the probability of feeling fulfilled and successful. Ideas can include:

- Topics you wish to address in the session
- Questions you may have for the counselor
- Specific behavioral goals you wish to work towards


For your first therapy session, we recommend you bring a journal or something to take notes. You may wish to write down topics that are covered in the session, such as the pain education we will review in session 1. You may also wish to write down your personal goals, intentions, and experiences you have during the session. Note-taking can be a great way to keep track of how you’re feeling and what exercises or interventions work for you. This can also be a great reminder for you to have between sessions in case you forget what was covered during the session.

An EOB is an explanation of benefits.  After the provider submits the claim to the insurance, the insurance processes the claim and sends an explanation of benefits to both the provider and the patient.  This explanation shows exactly how the insurance processes the claim they received from the provider.  It will show the charges, their allowed amount for each procedure or CPT done, what the patient is responsible for (copy, co-ins, and deductible), and what, if any was paid to the provider. OON patients EOB’s will state they are responsible for the full amount of charges because the provider does not have a contract with the insurance.  The following codes will be present on the EOB to represent the patient’s cost share responsibility, which represents what the provider must bill for.

PR-1 – Deductible
PR-2 – Co-insurance
PR-3 – Copayment
The following may also appear on the EOB – this will show the balance bill amount the patient may be charged for
PR-242 – services not provided by an in-network provider.

A deductible is a set amount that the patient and insurance agreed upon at the time of enrollment.  The higher the deductible, the lower the premium the patient pays to the insurance. Each year the deductible increases on the yearly date for the plan, usually in January for most patients.  The way the deductible works is your insurance plan will process your claim with an allowed amount and will apply whatever they allow and would have paid the provider to the patient’s deductible and the provider will not get paid and needs to collect that amount from the patient. The providers are legally obligated to collect these amounts from both their in-network and out-of-network patients.  The only way to know how much has been met is for the provider or patient to contact the insurance company and request the amount the patient still owes.

Co-insurance is a percentage a patient and their insurance company agree upon for payment.  Meaning, if a patient has a 20% coinsurance and their insurance allows $100 for the visit, the insurance will only pay $80 and the patient will be responsible for $20.

OON means that your provider has not been contracted with your insurance and has not agreed upon a set payment schedule from the insurance.  OON members may incur higher out-of-pocket costs and providers have the ability to balance bill members over any set cost share (deductible, copayment, coinsurance) the insurance deems their responsibility.  In order to know if a patient’s insurance plan carries OON benefits, either the patient or the provider’s office will need to call the patient’s plan and do a benefit verification.  Also, a patient would choose a plan at the time of enrollment with their employer or insurance agency that either does or does not have OON benefits.  Usually plans with OON benefits have a higher premium to the member.

There are several other therapies that may help our patients outside of MBCT. Some of the therapies train the body to relax, while others seek to create movement and body awareness. These other therapies may include:

- Mindfulness-Based Stress Reduction
- Hypnotherapy
- Exercise and Movement, including Qi Gong, Tai Chi, Restorative Yoga and Pilates
- Myofascial Massage
- Acupuncture and acupressure
- Pelvic floor physical therapy

We believe that counseling is most effective when the patient and counselor collaborate on resolving the client’s concerns. This process includes a willingness to challenge yourself to think about issues in new ways, be honest with yourself and your counselor, and follow through, to the best of your ability, on tasks and goals discussed in session.

It is possible that during the session you might experience uncomfortable or painful feelings. However, counseling has been demonstrated to have many benefits and clients often report significant improvements in the problems for which they sought help.

We urge people before our first session to talk with their insurance company about reimbursement. There are many different plans and they vary greatly when it comes to behavioral health services. Often, people are able to get a percentage. If your insurance covers behavioral health services, we will bill your insurance directly and you will be responsible for a copay after you have met your deductible. If you have a deductible, or if your plan does not cover behavioral health services, then we can issue a Superbill for our clients to submit for reimbursement. All sessions with Dr. Milspaw are cash-fee only.

We have a 24-hour cancellation policy. If the session appointment is rescheduled before 24 hours of the appointment time/date, there is no charge. If changes are made within 24 hours of the session you will be charged the full session fee. The same rules apply for appointment no-shows. We do realize there may be something going on and emergencies arise. Please call the office as soon as possible if you realize you are unable to keep your appointment.

We are able to work with patients to adjust the PRM Protocol™ to meet their travel timeline. Most often, patients opt to do the treatment in 3- weeks. They will come in on a Monday and get treated 2 times during a week and then do this over 3 weeks. It is important to know that this is an in-office treatment, so patients are able to travel on the same day.

Yes. Our surgical coordinator will set up a virtual consultation but you will have to have an in-person appointment with our team before we can proceed with your surgery.

Yes. We offer a courtesy 15-minute consultation for all patients, and we find that those traveling for treatment benefit from learning more about the PRM Protocol™ before committing to travel.

Yes. Our office coordinator in the local office will be happy to help answer your questions about the area and your travel.

We are treating both the nerves and muscles within the pelvis, and there are three major muscles on each side. Over the course of 6 weeks, each of these major muscles will be treated once and one at a time, for a full trip around the pelvis. Through this treatment, the nerves will start to desensitize and become more calm with each treatment.

Your muscles and nerves have been in a chronic state for a long time, and releasing them from this state will take time as well. Over the course of your 6 weeks of treatment, you will feel a reduction in inflammation due to the lessened restriction around the nerves, followed by less spastic nerves and muscles and a pelvic floor that is overall less painful and more functional.

As with all of your treatments, we will have you take your anti-inflammatory medication 2-3 hours prior to your appointment. This treatment is the same as all of your previous treatments, so it will take about 15 minutes, followed by sitting with ice prior to your departure.

The PRM Protocol™ is a series of external, ultrasound-guided pelvic peripheral nerve blocks that are provided over 6 weeks to release tension, improve blood flow, and to allow the nerves and muscles within the pelvic floor to become less spastic, resulting in decreased pain and increased function. Pelvic Floor Botox is a process that freezes the muscles in the pelvic floor in an effort to reduce pain by blocking the nerve signals between those muscles and the brain. Unfortunately we know that this pain reduction is not long-lasting, does not restore the patient’s desired function, and sometimes results in weakened pelvic floor muscles which can cause pelvic floor dysfunction.

We treat both sides of the pelvis, even if you are only experiencing pain on one side, because the nerves on the right and left sides talk to each other through the spinal cord, which goes down the middle of the pelvis. Additionally, there can be referred pain patterns within the pelvis that can cause this pain to go back and forth. Some patients can also experience compensatory spams on either side of their pelvis resulting from issues happening on the opposite side.

The point of PRM’s treatment is that it is extremely safe due to using ultrasound guidance which allows us to see where the needle is being placed, and the side effects of our treatment are less than 0.001%.

- Because our treatment aims to create space and force the muscles and nerves out of their tightened chronic-guarding state, patients may experience some soreness or aching following the injection. This is a normal reaction to space being created within the pelvic floor. You should always take the medication recommended by your pelvic pain specialist, and follow their directions for how to take care of yourself following treatment.

- We always watch for vasovagal, especially during a patient’s first treatment. This is a rare side effect that can be caused by patients being anxious about their appointments. We always combat this by providing our patients with a snack, and juice, and observing them while they sit on ice following treatment.

We also recommend that patients take their anti-inflammatory medications 2-3 hours prior to treatment, and sitting on ice in the office following their treatment is also helpful in preventing soreness or aching after treatment. If some pain does occur, we recommend trying a heating pad or soaking in a warm bath, accompanied by taking ibuprofen for any inflammation. Ice may also be used if that is soothing for you. In some cases, we may recommend using an extra suppository if the pain persists.

First, our providers will ask questions about your medical history and listen to your symptoms to get a full picture of what is going on with you.

Next, an external exam of your hips, abdomen, and posterior sacrum.

Next, your pelvic nerves are evaluated externally with a soft cotton tip.

Next, with your consent, gel is placed on a gloved finger and an internal exam is performed to allow us to evaluate the nerves and muscles within the pelvis. There is no speculum required as we are evaluating the pelvic floor muscles and nerves not the organs.

Sometimes patients will need Imaging to help us understand if there is an associated cause of the pelvic nerve and muscle pain and dysfunction found on the exam.

Oftentimes, treatment can be started the same day as there is no downtime. Our patients have been suffering with pelvic pain symptoms for 6+ months. We like to get them on the road to feeling better as soon as we can as the longer the symptoms are present the harder it is for us to resolve them.

A multimodal approach means you're doing multiple treatments at the same time. The idea behind this is that patients get the benefit of the synergistic nature of the treatments working together. An example would be the PRM Protocol™.

The goal of our treatment is to reverse, reset, and retrain the dysfunctional nerves and muscles in the pelvis that are associated with causing pelvic pain symptoms. Because the nerves and muscles have been in a chronic guarding state for so long, this does take some time. Over the course of your treatment, we are creating an environment in your pelvis where there is less inflammation, more blood flow, and less restriction around the nerves. With each treatment, the muscles will begin to relax into a state that is less spastic and less painful.

The exact cause of Chronic Pelvic Pain is not always clear. It can be caused by direct injury to the pelvis or coccyx, or secondarily, by disorders of the bladder, gynecological system, or gastrointestinal complaints. Often patients with pelvic floor dysfunction may have no pain, but only have complaints of urinary frequency or chronic constipation.

The treatment of Chronic Pelvic Pain Syndrome often involves multiple providers working together to ensure a successful outcome. We collaborate with the best specialists in the world including pelvic floor physical therapists, OB/GYNs, orthopedic surgeons, general surgeons, urologists, and urogynecologists. Our clinically proven treatments are effective in alleviating the underlying causes of pelvic pain and resolving muscular dysfunction.

It’s unlikely that Chronic Pelvic Pain will go away on its own. Many treatments that are helpful, like physical therapy, acupuncture, yoga, or surgery may not be enough on their own to resolve the pelvic floor dysfunction. We strive to ensure that all aspects that are contributing to your chronic pain are addressed in order to achieve excellent results.

Chronic Pelvic Pain is not a form of anxiety. However, it can be worsened by chronic stress and anxiety. Chronic pain can affect daily living and patients may develop anxiety secondarily to the chronic pain.

We treat patients regardless of the duration of pain. Patients who have been in pain longer may require additional courses of treatment, but a better quality of life can still be achieved.

Many physicians are not trained in pelvic pain during medical school or residency. There are still myths in both the medical and non-medical communities regarding pelvic pain. Treating pelvic pain is a specialty and requires a collaborative effort among different medical providers. We hope to remedy this by continuing to educate both the medical and non-medical communities. Greater community awareness will allow better access to pelvic care.

At your post-op appointment, you likely won’t have pain, which is great! But we want to be sure you are on a lifelong journey to no pain.

There are several separate charges associated with your surgical procedure. You MAY receive charges from several companies.

a. Your surgeon’s office – You may receive 2 separate surgeon’s bills. In some instances, 2 different providers perform your surgery – each submit charges for their services and are processed differently resulting in different patient responsibilities set by your carrier. PRM will bill you for these services. (Fee for performing your surgery, please refer below to question 3.)
b. Anesthesiologist – a fee for anesthesia services for surgery.
c. Pathologist – services for tissue specimens removed during surgery requiring further examination.
d. Laboratory – services for laboratory tests run on specimens removed during surgery.
e. Hospital – the hospital will submit a facility bill for all services during your stay. Any patient responsibility set by your insurance will be billed to you by the hospital.

We accept all major credit cards such as Visa, Mastercard, Discover, and American Express.

a. Processing of surgery bills takes anywhere from 8-12 months for the claim to be finalized by your insurance company.

b. The claim does not begin processing until your insurance carrier receives the bill – Surgeons may have a delay in their Op report recording and we have 30-45 days from the time of service to submit claims to your carrier.

c. There may be a delay if your insurance company has not paid all procedures during first-time processing and we have to appeal for additional processing, each appeal can take 45 to 60 days for processing from the date received (this is determined by your carrier) or we have re-submitted your claim for a corrected payment and allowance determination. We will bill you any balance due after your insurance company has processed your claim in full.

No.

Yes.

Please see your Surgical Financial agreement.

We will not know until the surgery has been sent to the surgery billing department (outside billing company) and has been coded and uploaded into their site for PRM to mimic their system.

Post op is 90 days post-surgery date that includes all E/M codes (visit checks) any other procedure/test/injections performed will be billed to your insurance and whatever they deem your responsibility you will receive a bill for as well as any PRM financial agreements.

No, unfortunately we cannot treat pregnant patients. However, patients with pain during pregnancy are at increased risk of post partum pelvic pain and pelvic floor dysfunction. Please come see us if you are having pain with intercourse lasting greater than 8 weeks after giving birth.

Put simply, no. We believe that behavioral health and nutrition are part of the PRM Protocol and emphasize a holistic approach to health, where we provide patients with a safe, supportive space to explore their health issues and goals. However, we believe it should be a part of the full protocol - everything at once is what makes it work! With The PRM Protocol, we go further than addressing the symptoms on the surface – we treat the underlying causes of pelvic pain.

They are both physicians who went to medical school and residency. The difference between them is one is a Medical Doctor and one is a Doctor of Osteopathic Medicine. Residency programs accept both MDs and DOs. It is common for Physiatrists to be DOs as the training is more focused on the neuromusculoskeletal system.

The providers at PRM are all pelvic pain specialists who are also endometriosis specialists - trained and specialized in anything from the belly button to the mid-thigh. But, more specifically, they are a combination of physiatry, family medicine, and nurse practitioners. Depending on the office location you visit, this may vary.

We know that excision surgery is the only way to REMOVE Endometriosis lesions and an important step to healing. However, overall at PRM our mission is to try and decrease the total number of surgeries our poor patients have to undergo in a lifetime as we often see patients who have repeat surgery after repeat surgery. Addressing comorbidities such as the pelvic floor and bladder before or after surgery can help optimize the surgical results and hopefully increase time before further surgery may be needed.

PRM is proud to use Healow Check In for our patient intake process. This allows us to streamline the intake process and make our patient experience focused on treatment and patient-provider interactions. At the time of scheduling, patients will be given access to eCW and their patient portal. Before their appointment, PRM patients will get a text that triggers them to login and complete all their intake forms – including questionnaire, health history, and consent forms – on their phones ahead of the appointment. This allows patients to tackle this ahead of their appointment to save time and give providers information ahead of time to review.

Yes. At PRM, we understand that receiving the necessary care or treatment may sometimes come with a financial burden. That's why we are proud to offer CareCredit financing. PRM patients can simply visit the CareCredit website to learn more about pre-approval or give us a call, and our team at PRM will guide you through the process. Patients may use CareCredit to help pay for deductibles and out-of-pocket expenses not covered by insurance.

PRM patients can simply visit the CareCredit website to learn more about pre-approval or give us a call, and our team at PRM will guide you through the process.

Yes. Our team works hard to ensure your visit is about your treatment and nothing else. Our team spends time with you and your insurance to understand your benefits, verify what coverage is available to you, and work to find pricing that fits your plan. At the time of schedule, we will work to verify your benefits and explain to you your benefits.

Please note that when scheduling your appointment, our team will collect a $50 payment upfront for OON and self-pay patients. If you are in-network, we will collect your co-pay. This is because we want you to come into the office and just be seen. We don't want patients to have to worry about filling out paperwork, fiddling with their insurance, payments, and more. We want you to be 100% focused on getting treatment and talking with the provider about their care plan. Should you need to cancel within 24 hours or reschedule, this is fully refundable, and the fee does go towards the cost of your visit.