Like all physicians’ offices, we have a long and complex fee schedule. For the PRP Stem Cell Joint Repair process, to simplify things for most patients, we try to fit whatever variable, complicated codes and fees are used each time, including tax, into a plain flat package fee for our two most common service scenarios:
- Initial evaluation: $425. (usually 1.5 to 2 hours)
- Each PRP Stem Cell procedure: $975. (usually about 1.5 to 2.5 hours)
Understand that the PRP Stem Cell procedures need to be performed not once but on roughly a monthly basis, most commonly for plus or minus 6 procedures. Understand that our fees are subject to change, though we change them only very rarely.
You must pay in full at the time of each service.
Checks, cash, and all major credit cards are accepted. We can accept debit cards and Visa/MasterCards from HSA’s – Health Savings Accounts.
If we determine that you have health insurance that is supposed to cover our services, you still pay in full at the time of each service, and then we serve you by billing your insurance company to have them reimburse the cost of services you received and paid for here. On your first visit, bring your insurance card for us to scan. We will also help you follow-up and appeal underpaid claims. We need you to share all correspondence you receive from your insurance company, in a timely manner.
We are, by our choice, not contracted with your insurance company. Said another way, we are not in-network. If your policy is an HMO or EPO (look for that on your insurance card), that means you do not have out-of-network benefits and there is no worth in us billing your insurance for our services. If you have out-of-network benefits, we can bill your insurance for our services. If your insurance card says “PPO”, then you might have benefits worth us billing. Know that you have a deductible and even after the deductible not everything will be paid. Perhaps your policy booklet says you get 50% or 70% coverage for out-of-network specialist office services; that may be so, but most insurance companies will try to reduce submitted fees before applying the 50% or 70%, meaning that more commonly patients receive a lower percentage of reimbursement. If you really want to more deeply understand how and why insurance companies make wild reductions in our charges, read this lengthy article about an investigation by The New York Times published 4/7/24. Nevertheless, we sincerely try to help our patients with their insurance.
Many people, ahead of coming here for evaluation, understandably think (or hope) they can phone their insurance company to find out what will be covered. This is a myth. This is simply not true. You may phone your insurance company JUST with the following questions:
- Do I have out-of-network benefits for specialist services?
- What is my deductible for out-of-network services, and how much of it has been met this year?
- After I meet my out-of-network deductible, at what percentage will I be reimbursed for specialist office services?
- Must I get pre-authorization for out-of-network specialist office services, including injections?
We encourage you to not get into discussions about what injections or what services, for you don’t know what codes will be billed, and we may not know until each procedure is finished.
If you have traditional Medicare and a supplement, we will not be able to bill our services for you. Medicare will not pay you for our services. Though you will still have to pay us in full at the time of each service, we may be able to bill and try to get you partial reimbursement from your
- Medicare related Advantage Plan, if it is not an HMO or EPO plan. Read this article for whether it is to your advantage to have an Advantage Plan. Here is another article about some disadvantages of advantage plans.
- Medicare related NM State Employee Retiree plan (BCBS or Pres), if it is not an HMO or EPO plan.
- Medicare related Federal Employee Plan (FEP) Retiree BCBS or GEHA plan
- some other Medicare related corporate retiree healthcare plans
We are not able to bill:
- Medicaid (for example Salud)
- military CHAMPUS/Tricare coverage
Auto med pay is also known as automobile medical payments, auto medical insurance, or PIP – a personal injury policy for medical care after a car crash. You have to find out if your automobile insurance policy has med pay, and how much. It may provides $2,000, $5,000 or possibly much more coverage for each person in a given auto accident, regardless of who was at fault. We would need to know if there is auto med pay on your own auto insurance policy, the policy of another person who owns the car, a policy of a member of your household, or the policy of a person that was driving you as a passenger. We would also need to know the amount of med pay coverage on the policy and the amount still unused and available for you for that accident. If available med pay coverage is confirmed, we are willing to bill the med pay and accept that as payment, up to the amount available. You are, of course, ultimately responsible for your full bill.
Don’t get confused by phone calls by the insurance company of the car that hit you. They may try to sweet talk you to say that they will take care of your medical bills. This is deceiving. They don’t pay a penny until you settle, sign off on all future liability, and close the case, and they are frequently full of tricks to pay you less than you’d think, commonly less than your bills. We usually advise patients that it might be in their interest to say little or nothing to the insurance company of the party that caused the accident, for they are your adversary.
You are responsible at the time of service for charges beyond what all available med pay policies pay us. If you have an attorney, we may consider at least discussing with you and your attorney the possibly of continuing our medical care and awaiting settlement of your case for payment. You are, of course, ultimately responsible for your full bill.
We accept payment from NM Workers Compensation. If you have a work comp claim, call and talk with us. We will need to get our services pre-approved by your adjuster ahead of time. Workers Compensation in NM does appropriately pay for PRP procedures. Federal Workers’ Compensation also pays correctly for our services. If you are covered under a NM or Federal WC case, you pay nothing for our services.
We do not make payment plans. We do not accept sliding scales for payment.
