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Private insurance/Worker's compensation
Private Insurance:
In-patient services:
Professional services from doctors and others for pain management services are usually paid at usual and customary rates depending on your particular insurance plan. Separate from professional fees are hospital fees for room, food, nurse, laboratory, pharmacy, etc. If your insurance company certifies you for hospital admission it will pay according to it's normal rates of coverage minus your deductible. This certification will be obtained by our office after your evaluation. During hospitalization, separate charges come from professional services and from hospital services.
Out-patient services:
As a residential out-patient your insurance may pay for some or all of your professional services. Only in the most rare circumstances will private insurance pay for your room, food, massage, and exercise aspects of your program. If they deem your residential out-patient treatment necessary and it is a normal part of your coverage they will pay their portion of covered services (ie., physician, psychologist, physical therapist, etc.) minus any remaining deductible you have. Thus, patients will likely only be reimbursed by their insurance company for some and not all of their treatment at Pacifica.
Usually our office can make a preliminary determination
of the extent of your insurance coverage if we have your
diagnoses and insurance information. We are happy to make
the call for you. Click
here if you would like to have us do that for you.
Worker's Compensation:
The requirements to receive treatment with Pacifica at St. Helena Hospital under most worker's compensation programs is fairly straight-forward. Your insurance will require the following:
- formal referral from your
doctor of record.
- verification from MD that comprehensive in-patient pain management services are not available in your region.
- permission from your worker's
compensation adjustor.
- and possibly review and
authorization from a utilization review committee.
- separate authorizations are usually needed for our evaluation and our treatment.
Each state's worker's compensation rules and laws
are different but with your doctor's referral (usually
written) to us for evaluation and treatment with his reasons
why will usually be enough to get the process started.
Click
here if you want us to help you get started.
The treatments we offer are billed separately for in-patient and residential out-patient services. Our bills are submitted under "professional services" codes.
Pre-authorization for hospital
admission and out-patient services should
be obtained in advance
by our office after completion of your evaluation. In
some instances, your insurance authorization can be facilitated
by you and your community physician prior to coming to
our evaluation. |
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