Insurance FAQ

 

A Note to Our Patients – PNBC’s Commitment to Health Care Value

We recognize that many of our patients pay various "out of pocket" costs for treatment at our clinics. This may involve co-pays, deductibles or withdrawals from medical savings accounts.

We want our patients to know that we deeply respect the financial commitment they make to participate in our treatment program. Further, we realize that our patients have the right, indeed the responsibility, to demand value for the services we provide. As we see it, ‘value’ means providing the most effective and lasting treatment outcome for the least amount of health care dollars spent.

We have demonstrated with insurance companies and through published data that patients who complete our program are 67% less likely to reutilize the medical system for spine care when compared to patients that elect other forms of treatment. In other words, money spent on our treatment yields greater value, because there is significantly less need to spend more money later on the same problem.

Also, we have demonstrated through published research that patients can often avoid the costly option of surgery by completing our program. We continue to document our outcomes on an ongoing basis so that our patients, referring physicians and insurance providers can judge our effectiveness.

Finally, we are very open to discussing flexible payment options with our patients as the need arises. We will never turn patients away for financial reasons.

Our pledge as a health care provider is to help stem the rising tide of health care costs through the most effective, lasting, and, value-based treatment available.


Blue Cross Blue Shield now ranks clinics based on quality. PNBC is proud to have been designated as Tier 1, the highest rating.

Insurance Coverage & FAQs
Physicians Neck & Back Clinics (PNBC)’s treatment is covered by almost all major health plans within Minnesota and Western Wisconsin. A referral may or may not be needed based on a patient’s specific health plan. However, if a referral is required, more than 1,500 physicians in the Twin Cities metro area have referred patients to PNBC. We also treat workers’ compensation patients and those injured in motor vehicle accidents. Following are some

Frequently Asked Questions regarding insurance coverage at PNBC:

  1. Do you accept my insurance?
  2. Do I have to pay a co-pay each time I attend the clinic?
  3. I have previously gone to physical therapy and not had a co-pay. Why do I have a co-pay here?
  4. Instead of paying at each visit, can you just bill me when I’m done with the program?
  5. Will my health insurance cover this treatment?
  6. If I call my health insurance carrier to inquire about my benefits, what should I ask them?
  7. What should I do if my insurance plan changes while I am coming to your clinic?
  8. I don’t have insurance. Can I still come to your clinic?
  9. I really think my pain is from an old work comp injury or a motor vehicle accident. Can you bill them instead of my private insurance?
  10. Does insurance pay for items such as ice wraps, therapeutic pillows, or Roman Chairs?
  11. How often do you send in claims to my insurance carrier?
  12. How will I know if my insurance carrier is paying for my treatment here?
  13. What is my current balance?
  14. Can you just send all bills do my attorney?
  15. If I have an attorney involved in my No Fault claim, do I need to sign a lien?

 

We currently accept:  

Aetna
Blue Cross Blue Shield
Definity
HealthPartners
Medica
Preferred One
UMR

United HealthCare
Workers’ Compensation
Motor Vehicle and liability claims

Most of the major Minnesota Medical Assistance and Medicare Replacement Plans

  1. There may be some additional insurance carriers that are not listed here. If you have any inquires please call our New Patient Coordinators at 651-735-2225.

    PNBC does not require a referral to attend our clinics. However, there are certain insurance companies that require patients to get a referral as we are considered a specialty clinic. Please refer to your insurance plan to see if you fall in that category.

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  2. Do I have to pay a co-pay each time I attend the clinic?

    It depends on what level of healthcare benefits you have. In most cases, this information can be found on your insurance card. If not, you can find out by simply calling your insurance carrier. Some co-pays are a flat amount such as $15 at each visit. Other policies have a co-insurance instead of a co-pay. This means that instead of a flat fee, you are responsible for a certain percentage of the bill at each visit. If you have co-insurance, PNBC will bill you for that monthly rather than collecting it at the front desk before each visit.

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  3. I have previously gone to physical therapy and not had a co-pay. Why do I have a co-pay here?

    There could be several reasons for this. Your insurance benefits may have changed. Some policies have different reimbursement levels depending on the setting. Perhaps your previous therapy was performed in a hospital setting while this therapy is at an outpatient clinic. Perhaps when you were attending physical therapy previously you had fully met your deductible, but this year you have not. Your obligation may change depending on whether or not PNBC is in your approved network of providers. Your obligation may also vary depending on whether or not you have a physician referral. Much of this information may be on your insurance card, but if not, you will have to call your insurance carrier. PNBC is an approved provider for almost all networks in the Twin Cities, but check with your insurance carrier or the PNBC front desk personnel to be sure.

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  4. Instead of paying at each visit, can you just bill me when I’m done with the program?

    No. We must collect co-pays at each visit.

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  5. Will my health insurance cover this treatment?

    Almost all insurance carriers cover the Physical Medicine delivered at PNBC, but you need to call your insurance carrier to be sure.

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  6. If I call my health insurance carrier to inquire about my benefits, what should I ask them?

    Ask them about the following:
    a) What are my physical therapy benefits?
    b) What is my deductible?
    c) What is my physical therapy co-pay?
    d) If I have coinsurance rather than co-pay, what is the percentage of the bill that I am responsible for at each visit?
    e) Is PNBC an approved provider for me?
    f) Do I need a referral to go to PNBC? (With some policies you may not need a referral, but without one you will pay more. You should ask about this.)

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  7. What should I do if my insurance plan changes while I am coming to your clinic?

    Be sure to inform the front desk personnel or the PNBC billing department. Please bring your new insurance card in for the front desk personnel to photocopy.

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  8. I don’t have insurance. Can I still come to your clinic?

    Yes. We offer a self pay financial agreement for people without insurance. Payment of $150.00 is required at the time of service for each visit. The remaining balance will be billed to you at the end of the treatment program. If you are financially unable to pay, you may be eligible for our Charity Care Policy. Please contact Terri Dolan at [651-735-6100 ext. 16) for more information about PNBC's Charity Care Policy.

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  9. I really think my pain is from an old work comp injury or a motor vehicle accident. Can you bill them instead of my private insurance?

    Yes, if the claim is still open. If not, it will not be covered. You can determine whether or not your claim is still open by contacting the work comp carrier (you may need to call your employer at the time of the injury to find out the name of the company and how to contact them) or your automobile insurance company.

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  10. Does insurance pay for items such as ice wraps, therapeutic pillows, or Roman Chairs?

    Most workers compensation insurance will usually cover these types of supplies. Private plans or No Fault auto insurance typically will not pay for these types of medical supplies, but this is not always true. You will need to contact your insurance company to determine their specific policy.

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  11. How often do you send in claims to my insurance carrier?

    Weekly. The only exception to this is for people with BlueCross BlueShield insurance. In this case, the bill is sent after 10 treatments.

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  12. How will I know if my insurance carrier is paying for my treatment here?

    You will receive an “Explanation of Benefits” form in the mail that will show the payment being made or give reasons for any denials.

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  13. What is my current balance?

    Our billing personnel can help you with this question. To reach our billing office, you can simply call the clinic directly. At some clinic locations, you will hear a recorded option to select to be connected with the billing office. At other locations, our front desk personnel can assist you in reaching the billing office.

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  14. Can you just send all bills do my attorney?

    No, but each patient can forward bills to his/her own attorney for payment.

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  15. If I have an attorney involved in my No Fault claim, do I need to sign a lien?

    Yes, if you don’t have private insurance and/or don’t want to pay co-pays.



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