The Pain Clinic of Northwestern Wisconsin is an independent physician group whose services are provided in an outpatient setting. Most procedures and services are performed in the hospital, and patients are admitted to the facility where they are being treated. Other types of procedures and services are performed in an office setting in which the Pain Clinic of Northwestern Wisconsin rents office space from the hospital.

If you are being admitted through the hospital as an outpatient, you will receive two bills. One is from the Pain Clinic of Northwestern Wisconsin for the physician services provided; the second is for the facility charges from the hospital where you were seen. The Pain Clinic of Northwestern Wisconsin billing staff is happy to assist you with any questions you may have about your account or balance with us. If you have questions about a hospital bill, we would ask that you please contact the appropriate facility.

Our Responsibilities

• We understand that health insurance can be confusing. Therefore, while it is ultimately your responsibility to know your insurance plan, we will make reasonable efforts to assist you by
• Scheduling you at a location covered by your insurance company.
• Preauthorizing your visit if required. (Please see the section on Preauthorization.)
• As a courtesy to you, our office will send bills for our services to your insurance company on your behalf.
• We will bill your insurance company in a timely manner.
• We will keep your personal medical and account information confidential according to state and federal law.

Patient Responsibilities

• To help us bill your insurance accurately and in a timely manner, we will need some assistance from you. We would ask you provide our office with the following:
• A copy of your current insurance card. We will ask for this at each visit.
• Accurate demographic information (address, phone number, etc.)
• If your visit is related to an injury, please provide appropriate information (date of injury, location, employer, worker’s compensation carrier, etc.)
• Pay your bill on time (within 30 days of receiving a statement).
• Know whether prior authorization from your insurance company is required in order for the insurance company to pay the bill.
• Know whether or not our physicians and/or the facility where you are being seen are providers for your insurance plan.

Preauthorization

Preauthorization means getting approval from your insurance company before coming for your appointment. Not all insurance companies require a prior approval.

Sometimes insurance companies have special requirements for providing coverage for pain services. Some insurance companies require preauthorization for all types of services, while others require preauthorization only for certain procedures.

If our office is aware that you have an insurance plan that requires preauthorization, we will submit the appropriate information to your insurance company in order to get your visit and service approved. Also, there are some services that our office always preauthorizes, regardless of the insurance plan.

Please remember that it is up to you to understand the requirements of your individual insurance plan and that if a visit is not approved, your insurance company may not cover the service and you may be responsible for the bill.

Insurance Payment & Patient Responsibility

Most insurance companies do not cover 100% of the cost of services, and there is a portion that the patient is responsible for. There are several patient responsibility components that may apply to an insurance payment.

Deductible – A set annual amount that the patient is responsible for paying prior to his or her insurance making a payment.

Co-pay – A set dollar amount per office visit that is the patient’s responsibility.

Co-insurance – A percentage of the charge that the patient is responsible for.

Because of the contract you have with your insurance company, we are obligated to collect payment from you for your portion of the balance.

Payment Methods

We accept a variety of payment methods, including cash, check, money order, or credit card (Visa/MasterCard). Credit card payments may be accepted via phone, and the minimum credit card payment accepted is $15.

If you do not have insurance coverage and will be paying for the services yourself, a down payment may be required by the Pain Clinic of Northwestern Wisconsin and the facility where you are being treated.

We understand that there may be times and circumstances that come up where you are unable to pay your entire bill. In these situations it is VERY important that you contact our billing department so a representative can assist you in setting up a reasonable plan and to keep your account from being sent to a collection agency.