In New Mexico, a Spine Injection

Can Cost You from

$238

to

$5,631

Wouldn't you rather have the $238 shot?

The Cost Depends on WHERE YOU GO

Read On and Save Money

Do you know about Facility Fees also known as Site of Service Fees?

Medical billing and coding can be extremely confusing. There are number codes for your diagnosis, there are number codes for the procedures you have done and there are number codes for where the procedures are done. One code that you may have overlooked but should know about is the site of service code.

For a Single Epidural in a Doctor's Office
Medicare Allows from $247 to $270

The site of service code is extremely important for your bottom line. A service performed in an off campus outpatient hospital an on campus outpatient hospital and an ambulatory surgery center will cost you significantly more than a service in an office.

A Fair Price for a Single Epidural Injection Should Be No More than $505

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Do the Math

Unless You Inform Yourself, You Could Pay 99% or More for the SAME SERVICE

Anytime you see a physician who is part of a hospital based physician group and within a certain number of miles of that hospital or you go to a hospital or a day surgery or a rehabilitation center to have a procedure done, one of the costs of that procedure is what is known as a site of service fee or a facility fee.

Take Charge of Your Medical Costs

Ask the Following Questions

  • Where? Facility or Office?

    Ask where your procedure will be performed. If it is in a surgery center, a hospital, a rehabilitation center, or an off campus hospital facility, you WILL have a site-of-service or a facility fee.

    BEWARE of the off campus hospital facility that looks like an office. ASK if there is a site of service or a facility fee.

    ALWAYS get an estimate of the charges for your procedure.

  • In-Network or Out-of-Network?

    Just as important as knowing where your procedure is being performed is knowing who is performing it.

    REMEMBER TO CHECK if BOTH the FACILITY and the PHYSICIAN are in-network. If one or the other is out-of-network, you could be in for a nasty surprise.

  • Authorization?

    ALWAYS check if you need an authorization for your procedure. If the physician and/or facility are in-network, then it may be the physician or the facility's obligation to get the authorization if necessary. If one is not required, and the insurance plan decides that the procedure is medically unnecessary, guess what? You are on the hook for the costs of the procedure—and the cost is whatever they charge.

    Call your insurance plan. Ask if they will do a preauthorization for the procedure. If they do, get it in writing. Ask for a benefits analysis and find out what your portion of the bill will be.

    Don't leave yourself open to to a nasty SURPRISE.

  • Copay? Coinsurance? Deductible?

    We cannot say it enough. ASK FOR A BENEFITS ANALYSIS BEFORE you have any type of procedure. FIND OUT what portion of the procedure you must pay for as a copay, as a deductible and/or as coinsurance.

    Remember your costs don't disappear once you've met your deductible. You are on the hook for coinsurance until you meet your maximum out-of-pocket fees. This amount is usually fairly high and in the thousands of dollars.

The health care blue book estimates that a patient in New Mexico with a commercial insurance plan may be charged between $239 (the Medicare rate) and $5,631 (the highest commercial rate) for an epidural injection. The site further suggests that $505 is a fair price for that service.

What You Don't Know Can Hurt You

If you have that same procedure done in a facility, such as a day surgery or a hospital, you will have two charges. The first charge is for the use of the facility. The second charge is the doctor's fee.

It's important to realize that the doctor who performs the procedure in the surgery center is only getting paid a fraction of the fee that goes to the facility.

For a Single Epidural in a Surgery Center
Medicare allows between $644-$654.26

Commercial Plans Will Charge

Up to $5631

At Pain Solutions, We List Our Fees. No Suprises Here. We Believe in Transparency