Prior Medical Records

If you have scheduled an appointment with one of our physicians, please bring all relevant medical records related to your pain condition. This includes prior consultation notes, MRI reports, X-rays, and CT (CAT) scans. Providing these records helps prevent duplicate testing and allows us to develop a more efficient and effective treatment plan.

Insurance Information

To ensure timely verification of benefits, please bring your insurance card to your appointment. We will bill your insurance provider directly for covered services.

All co-payments are due at the time of your visit. We accept cash, personal checks, Visa, MasterCard, Discover, and American Express. A $25.00 service fee will apply to any returned checks.

Medicare Patients

Patients covered by Medicare are asked to provide the name and address of their primary care or family physician. It is important that your primary physician is informed of any care you receive from other providers.

Workers’ Compensation

If your pain condition resulted from a work-related injury, we will bill your workers’ compensation insurance carrier. To proceed, we must receive the following information:

• Name and address of the workers’ compensation carrier

• Name and phone number of your claims adjuster

• Date of injury

• Name and address of your employer at the time of injury

You must be referred to American Pain & Wellness by your treating physician. If you do not currently have a treating physician, we may consider assuming that role. Authorization from your adjuster or case manager is required prior to your initial consultation.

Referrals

Patients enrolled in an HMO plan must obtain a referral from their primary care physician (PCP). The referral must originate from your PCP, even if another specialist recommended our services. You are responsible for obtaining and maintaining valid referrals for all visits.

Patients who arrive without a required referral may be asked to reschedule or pay for services at the time of the visit.

Treatment & Procedures

If your physician determines that a medical procedure is necessary, our office will request pre-certification from your insurance provider before scheduling. Authorization is required and typically takes five to seven business days. HMO plans may require additional time due to referral requirements.

Most procedures are performed on an outpatient basis at Presbyterian Hospital of Plano or Parker Road Surgery Center, located on our campus. Professional fees are billed by the physician, while facility fees are billed separately by the hospital or surgery center.

Medications

If your treatment plan includes prescription medications, you will be required to review, sign, and comply with our Medication Agreement prior to receiving prescriptions.

Important Insurance Information

Health insurance coverage plays a significant role in pain management care. Please note that insurance policies are agreements between patients and their insurance providers. While we assist in verifying benefits and submitting claims, we cannot guarantee payment or negotiate claim disputes on your behalf.

If your insurance carrier pays only a portion of the charges or denies a claim, you are responsible for the remaining balance. If payment is not received within 45 days, we reserve the right to bill you directly. Claims delayed or denied due to coordination of benefits issues become the patient’s responsibility after 30 days.

Any changes to your insurance information—including provider, policy number, co-pay, or billing address—must be reported at least 48 hours prior to your appointment. Failure to do so may require payment in full at the time of service.

Pre-Certification Process

Many procedures require prior authorization. Our experienced insurance team works diligently to obtain approvals as quickly as possible; however, the process may take five to seven business days depending on your insurance carrier’s requirements. You will be contacted to schedule your procedure once authorization is secured.

To ensure efficient processing, we kindly ask patients to avoid frequent calls regarding authorization status, as this can delay communication with insurance providers.

Cancellations & Rescheduling

If you need to cancel or reschedule an office visit or procedure, please notify us at least 24 hours in advance.