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Insurance Information

Understanding insurance coverage can feel overwhelming, especially when you’re focused on managing pain and feeling better. We’re here to make the financial side of your care as clear and stress-free as possible.

Please see the list below of our accepted insurances by state.

Most copays range between $22 and $45.

Kentucky & Indiana

Ohio

Illinois

West Virginia

Virginia

Tennessee

South Carolina

North Carolina

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We Accept Most Major Insurances
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Frequently Asked Insurance Questions and Common Definitions

Insurance FAQs & Common Definitions

Below, you’ll find answers to frequently asked questions about insurance, billing, referrals, and authorizations, along with a helpful glossary of common insurance terms. If you have additional questions, our team is always available to help guide you through the process.

  • Insurance FAQs

    • Does Commonwealth Pain & Spine accept my insurance?
      Commonwealth Pain & Spine works with many major insurance providers. Because coverage can vary by location and plan type, we recommend contacting our office prior to your appointment to verify participation with your specific insurance plan.
    • Do I need a referral to see a pain management specialist?
      Some insurance plans require a referral from your primary care provider before seeing a specialist. Others allow you to schedule directly. Our team can help determine whether your plan requires a referral to avoid delays in care.
    • What is prior authorization, and will I need one?
      Certain procedures and treatments require approval from your insurance company before they are performed. This is known as prior authorization. Our office works directly with your insurer to obtain any required approvals and will keep you informed throughout the process.
    • How much will my appointment or procedure cost?
      We do our best to provide cost estimates based on your insurance benefits. However, final costs depend on your specific plan, whether you've met your deductible, and how your insurance processes the claim.
    • What should I bring to my first appointment?
      Please bring: Your insurance card A valid photo ID Referral documentation (if required) Any recent imaging reports or medical records related to your condition Having this information helps us verify benefits and coordinate your care efficiently.
    • What if I have a high-deductible health plan?
      If you have a high-deductible plan, you may be responsible for more out-of-pocket costs until your deductible is met. Our billing team can review your benefits and discuss payment options in advance.
    • Why did I receive a bill after my visit if I have insurance?
      Even with insurance coverage, you may be responsible for copays, deductibles, coinsurance, or services not fully covered by your plan. Once your insurance processes the claim, any remaining balance will be billed to you.
    • What happens if my insurance denies a procedure?
      If a service is denied, we will review the decision and, when appropriate, submit additional documentation or file an appeal on your behalf. Our goal is to advocate for medically necessary care while keeping you informed.
    • Do you offer payment plans?
      If you have out-of-pocket expenses, our billing department can discuss available payment options and work with you to establish a manageable plan.
    • What if I do not have insurance?
      If you are uninsured, please contact our office prior to your appointment. We offer self-pay options and can provide information about expected costs before treatment.

  • Common Insurance Terms & Definitions

    • Copay
      A fixed amount you pay at the time of your visit, as determined by your insurance plan.
    • Deductible
      The amount you must pay out-of-pocket each year before your insurance begins covering certain services.
    • Coinsurance
      The percentage of medical costs you share with your insurance company after your deductible has been met.
    • Out-of-Pocket Maximum
      The maximum amount you will pay during a policy period (usually one year). After reaching this limit, your insurance typically covers 100% of eligible services.
    • Prior Authorization
      Approval required from your insurance company before certain treatments or procedures can be performed.
    • Referral
      Written approval from your primary care provider that some insurance plans require before you can see a specialist.
    • In-Network Provider
      A healthcare provider who has a contract with your insurance company to provide services at negotiated rates.
    • Out-of-Network Provider
      A provider who does not have a contract with your insurance plan. Visiting an out-of-network provider may result in higher out-of-pocket costs.
    • Explanation of Benefits (EOB)
      A statement sent by your insurance company explaining how a claim was processed, what was paid, and what portion you may owe. An EOB is not a bill.
    • Claim
      A request submitted to your insurance company for payment of medical services provided during your visit.
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