Office Information for American Pain and Wellness in Plano, TX & Allen,TX
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Office Info / Office Procedures
Welcome to American Pain & Wellness, our main office is located at 6020 W. Parker Rd suite #300 on the 3rd floor in Plano. Our office hours are Monday – Thursday: 8:00 AM – 5:00 PM and Friday: 8:00 AM – 12:00 PM.
PRIOR MEDICAL RECORDS
If you schedule an appointment with one of the doctors at American Pain & Wellness, we asked that you bring your medical records from other doctor(s) that have treated you for the pain symptoms when you come for your appointment. Please be sure to include any reports of MRI=s, x-rays, or CAT Scans. This will prevent diagnostic testing from being ordered again and could also expedite your treatment plan.
Please fax a copy of your insurance card to us at (469) 326-5101 prior to your appointment. This will allow us to verify your benefits prior to your first office visit. We will bill your insurance company for services rendered. All co-payments are due at the time of the office visit. We accept cash, personal checks, Visa, MasterCard, Discover and American Express. A $25.00 service fee will be charged for returned checks.
If you have Medicare coverage, your family physician should be aware of your medical treatment by other doctors. Please furnish us the name and address of your family physician.
WORKER’S COMPENSATION INSURANCE
If your pain problem is due to a work related injury, we will be glad to bill your worker=s compensation carrier. To do so, we must have the name and address of the carrier, the name and phone number of your adjuster, and the date of your injury. We will also need the name and address of your employer at the time of your injury. You will need to be referred to American Pain & Wellness by your treating doctor. If you do not have a treating doctor, we will be glad to consider becoming your treating doctor. Your adjuster or case manager will need to authorize your initial consultation with American Pain & Wellness.
If you are a member of an HMO, you must obtain a referral from your primary care physician. Your primary care physician’s name should be listed on your card. The referral must come from the primary care physician, not from another specialist even if the specialist is the one referring you to us. You are responsible for obtaining your referral. You will be responsible for keeping your referrals current for all future visits. If you arrive for your appointment without a referral, it will be necessary to either reschedule your appointment or you will need to pay for the visit at the time service is rendered.
If the physician at American Pain & Wellness determines that your treatment requires a procedure(s), we will call your insurance company for pre-certification. We must obtain the pre-certification before scheduling the procedure. It could take from five (5) to seven (7) working days to obtain authorization. Procedure pre-certs for HMO patients may incur additional delays, as the primary care physician must furnish additional referrals for all procedures, diagnostic testing, and physical therapy.
Most procedures are done on an outpatient basis at either Presbyterian Hospital of Plano or Parker Road Surgery Center (which is located here on campus). Your insurance company will be billed by the doctor for his professional fees. Presbyterian Hospital of Plano or Parker Road Surgery Center will bill your insurance carrier for the facility fee. Payment to the facility does not include payment of the doctor’s professional fees.
If your treatment plan at the American Pain & Wellness includes prescribing medication, we will ask you to read, sign and then comply with the following Medication Agreement:
FACTS ABOUT INSURANCE
Health insurance plays a large role in helping people obtain pain management treatment. In an effort to help you understand your health coverage we would like to share some facts about healthcare insurance.
- You may receive a letter from your insurance company stating that medical fees are higher than usual and customary. An insurance company surveys a geographic are, finds the average fee, and then takes 90% of that fee and considers it customary. Included in the fee survey are discount clinics which can bring down the average fee. Many doctors in private practice have fees that are considered higher than average.
- If you have insurance, we will be happy to help you determine the coverage you have available. Your insurance policy, however, is a contract between you and your insurance company. We cannot guarantee payment of your claims or accept responsibility of negotiating claims with insurance companies or other persons. If your insurance company pays only a portion of the bill or rejects your claim, you are responsible for full payment of services rendered. If payment from your insurance carrier is not received within forty-five (45) days, we reserve the right to seek full payment from you. Balance of services that are delayed or denied by your insurance company due to Coordination of Benefits information become your responsibility after thirty (30) days. We encourage you to become familiar with your particular insurance benefit plan and philosophy of its administration.
- If there are any changes in your insurance status (i.e. new company, deductible, co-pay amounts, group number, mailing address for claims, etc.) you must provide us with the new information within forty-eight (48) hours in advance of next visit or payment in full will be necessary.
- Most of our procedures will require precertification prior to the procedure being scheduled. Our office staff works diligently on your behalf to obtain these precertifications. The process of precertification is often different depending on the requirements set forth by your insurance carrier. Our insurance specialists are well trained in this area and will work to obtain authorizations as quickly as possible. This could take before five (5) to seven (7) business days. Our schedulers will call you to schedule the procedure as soon as the authorization is obtained.
- Please be assured that our office staff are professionals in processing insurance issues. Patient calls on a daily or regular basis to inquire about the status of precertification both overloads the phone lines used for precerts and it also delays the staff’s ability to appropriately triage their time in obtaining the precertification from your insurance company.
If you need to cancel or reschedule an appointment for an office visit or a procedure, we ask that you please call twenty-four (24) hours in advance.