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Health Insurance Coverage & Benefits Education

We Help You Understand and Maximize Your Health Insurance Coverage

Navigating health insurance shouldn’t feel like performing spine surgery without a license. 

At University Pain & Spine Center, our experienced team is here to break down the barriers between you and the care you deserve. Whether you’re dealing with complex spine conditions, chronic pain, or recovering from an injury, we help you make sense of your insurance benefits—so you can focus on healing, not billing.

We proudly work with Commercial Insurance Plans, Medicare, No-Fault (Auto Accident/PIP), Workers’ Compensation, and Out-of-Network PPO Plans across New Jersey and New York.

What We Offer: Insurance Navigation, Verification & Advocacy

Free Insurance Verification: No guessing games. We confirm coverage before your visit.

Click here to check if you're covered

Out-of-Network Support: Get help understanding deductible status, coinsurance, balance billing, and arbitration options under the No Surprises Act.

Medical Necessity Support: Our clinical documentation helps ensure that authorizations and claims are approved faster.

Direct Insurance Liaison: We coordinate directly with adjusters, employers, and claims departments—so you don’t have to.

Accepted Insurances & Programs

We are proud to work with the following types of insurance coverage:

  • Medicare Part B
  • Most Major Commercial PPOs (Aetna, BCBS, Cigna, United, Oxford, etc.)
  • Auto Accident (PIP) / No-Fault Insurance
  • Workers’ Compensation Programs (NJ & NY)
  • Out-of-Network PPOs (We can often work with you even if we are not in-network)

If you’re unsure whether your insurance covers spine surgery, interventional pain procedures, or follow-up care, we can help.

Key Insurance Terms: A Quick Glossary for Patients

Deductible
The amount you must pay out-of-pocket before your insurance plan begins to pay. This often resets annually.

Copay (Copayment)
A fixed amount you pay at each visit (e.g., $40 per specialist appointment).

Coinsurance
A percentage of the cost you share with your plan after your deductible is met (e.g., 20%).

Out-of-Pocket Maximum
The most you’ll have to pay in a plan year. Once reached, insurance covers 100% of additional costs.

In-Network vs. Out-of-Network

  • In-network providers have contracted rates with your insurer.
  • Out-of-network providers can offer greater flexibility, shorter wait times, and access to specialized care that may not be available in-network. While patient cost-sharing may vary depending on your plan, many PPO policies include generous out-of-network benefits—and our team is here to help you understand exactly what’s covered and what’s not.

Prior Authorization
A requirement from your insurer to approve a test, procedure, or medication before you receive it. We handle these on your behalf.

Explanation of Benefits (EOB)
A statement from your insurance—not a bill—that explains what was paid, what wasn’t, and why.

Referral
A formal request from a PCP (primary care provider) to see a specialist. This is common for HMO plans.

Out-of-Network Doesn’t Mean Out of Options

You may have out-of-network benefits and not even realize it. Our insurance specialists can walk you through:

  • Understanding your deductible and coinsurance obligations
  • Determining whether preauthorization is required
  • Verifying if you qualify for No Surprises Act protections
  • Estimating what your insurance will pay vs. your responsibility

We regularly help patients maximize their OON benefits using legal and compliant tools like IDR (Independent Dispute Resolution), appeal letters, and negotiated reimbursement strategies.

Still Have Questions? Call Our Insurance Help Desk

Our trained team is here to help with:

  • Insurance eligibility questions
  • Coordination of benefits (especially for PI/WC cases)
  • Updating your records after job changes or new plans
  • Appeals and coverage disputes

Let’s make insurance easy—so you can get back to living your life.

Serving New Jersey & New York

Same-day appointments are often available. Telehealth options may be covered under your plan.

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