At PRM, we are proud to be in-network providers with Blue Cross Blue Shield in most locations. Additionally, PRM participates with most major health insurance plans as non-par providers. Your out-of-pocket payment will vary according to the specifics of your plan and services. Unfortunately, we do not participate with Medicare, Medicaid, Emblem Health, GHI, Humana, and Tri-Care.
If your plan does not offer out-of-network benefits, PRM does offer significantly reduced self-pay rates and CareCredit financing to further our mission to enhance patient access to care. Our expert-trained patient advocate and expert billing teams can help you and support you through any of your financial questions or concerns.
Please note, any deductible or co-insurance that your insurance plan deems your responsibility you will receive a statement for.
At PRM, we know the average patient spends $29,951 on in-network treatments, diagnostics, and surgeries that provide minimal sustained relief. With that in mind, at the core of our mission is providing patients with affordable access to the care they deserve.
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.
We are not interested in increasing the financial burden on pelvic pain patients. PRM is proud to offer payment plans pre and post-treatment to reduce the financial burden on our patients.
For patients who are using their insurance, we have a dedicated team that will work tirelessly to advocate on your behalf to your insurance company.
We have a very rigorous process to ensure services rendered are covered. In the event they do not, we have a very robust appeals process to ensure any patient responsibility is minimal.
At the core value of our mission, we are striving every day to continue to advocate and educate the insurance industry on the burden of pelvic pain and increase awareness of the need for enhanced coverage and access to care for patients.
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, a convenient and flexible payment solution that allows you to prioritize your health without delay. CareCredit lets you say “yes” to recommend treatment and pay for it in convenient monthly payments that fit your budget.* 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.
*Subject to credit approval. Minimum monthly payments required. Ask us for details.
BCBS – In-network
Cigna – if coverage includes out-of-network benefits.
Aetna – if coverage includes out-of-network benefits.
United Health Care – if coverage includes out-of-network benefits.
*If your insurance carrier is not listed above but your insurance plan does have out-of-network coverage we will work with your plan.
CareCredit Financing – Apply now to see if you prequalify!
BCBS – In-network
Cigna – if coverage includes out-of-network benefits.
Aetna – if coverage includes out-of-network benefits.
United Health Care – if coverage includes out-of-network benefits.
*If your insurance carrier is not listed above but your insurance plan does have out-of-network coverage we will work with your plan.
CareCredit Financing – Apply now to see if you prequalify!
BCBS – In-network
Cigna – if coverage includes out-of-network benefits.
Aetna – if coverage includes out-of-network benefits.
United Health Care – if coverage includes out-of-network benefits.
*If your insurance carrier is not listed above but your insurance plan does have out-of-network coverage we will work with your plan.
CareCredit Financing – Apply now to see if you prequalify!
BCBS – In-network
Priority Health- In-Network
Cigna – if coverage includes out-of-network benefits.
Aetna – if coverage includes out-of-network benefits.
United Health Care – if coverage includes out-of-network benefits.
*If your insurance carrier is not listed above but your insurance plan does have out-of-network coverage we will work with your plan.
CareCredit Financing – Apply now to see if you prequalify!
BCBS – In-network
Cigna – if coverage includes out-of-network benefits.
Aetna – if coverage includes out-of-network benefits.
United Health Care – if coverage includes out-of-network benefits.
*If your insurance carrier is not listed above but your insurance plan does have out-of-network coverage we will work with your plan.
CareCredit Financing – Apply now to see if you prequalify!
BCBS, CareFirst, Anthem – In-network
Cigna – if coverage includes out-of-network benefits.
Aetna – if coverage includes out-of-network benefits.
United Health Care – if coverage includes out-of-network benefits.
CareCredit Financing – Apply now to see if you prequalify!
BCBS, CareFirst – In-network
Cigna – if coverage includes out-of-network benefits.
Aetna – if coverage includes out-of-network benefits.
United Health Care – if coverage includes out-of-network benefits.
*If your insurance carrier is not listed above but your insurance plan does have out-of-network coverage we will work with your plan.
CareCredit Financing – Apply now to see if you prequalify!
BCBS – if coverage includes out-of-network benefits.
Cigna – if coverage includes out-of-network benefits.
Aetna – if coverage includes out-of-network benefits.
United Health Care – if coverage includes out-of-network benefits.
*If your insurance carrier is not listed above but your insurance plan does have out-of-network coverage we will work with your plan.
CareCredit Financing – Apply now to see if you prequalify!
BCBS – if coverage includes out-of-network benefits.
Cigna – if coverage includes out-of-network benefits.
Aetna – if coverage includes out-of-network benefits.
United Health Care – if coverage includes out-of-network benefits.
*If your insurance carrier is not listed above but your insurance plan does have out-of-network coverage we will work with your plan.
CareCredit Financing – Apply now to see if you prequalify!
BCBS – if coverage includes out-of-network benefits.
Cigna – if coverage includes out-of-network benefits.
Aetna – if coverage includes out-of-network benefits.
United Health Care – if coverage includes out-of-network benefits.
*If your insurance carrier is not listed above but your insurance plan does have out-of-network coverage we will work with your plan.
CareCredit Financing – Apply now to see if you prequalify!
Medicare/Medicaid plans or HMO Medicare/Medicaid plans
Tri-Care
Humana
GHI
Emblem
However, if you do not see your provider, apply now to see if you qualify for CareCredit financing!
Chronic pelvic pain can seriously affect the lives of both men and women, as it can be caused by gynecologic, urologic, gastrointestinal, and musculoskeletal conditions. This can affect one’s ability to rest, have intercourse, go to work, and any other daily life activities. A study that included research by Pelvic Rehabilitation Medicine determined that the cost for those who seek and receive treatments for chronic pelvic pain is well into the tens of thousands of dollars, often for treatments that provide limited sustained relief.
Most interestingly, the economic burden associated with endometriosis was estimated to be $69.4 billion by analyzing 12 tertiary centers in 10 European Countries.
At PRM, access to care is at the core of our mission. We want to make sure our patients understand their options for paying for their treatment. Any questions that are not answered below may be answered by our billing specialist.
You can decide to go self-pay. We will honor that decision, but you have to decide upfront and maintain that decision for the duration of your treatment.
We will move forward with the new patient appointment and once we receive the clinical note from your new patient appointment, we will work to obtain the prior authorization and can move forward with your treatment.
We will work with you to contact your PCP and provide any needed information to administer the referral.
No.
Yes.
Co-insurance is a percentage a patient and their insurance company agree upon for payment. What this means is 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 providers’ 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.
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 resets 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.
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 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 (copay, co-in, 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 patients’ 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
We always recommend patients check out the No Surprises Act terms sheet. Of course, we are always available to help patients understand their bills or EOB.
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.
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.
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.
It’s time to change what going to the doctor for pelvic pain is like. It’s time to talk about it. The stigma ends as soon as you give us a call.