Billing, Insurance and Pricing
Participating Health Plans
Currently, UPMC is participating with:
Basic Medicare Part B insurance
Saint Peter’s University Hospital Inner Circle
Medicare HMO Plans only cover service provided by providers who participate in the network.
We are actively negotiating with the commercial health plans for participation agreements. We will update this page once agreements are made.
Know Your Benefits
It is important to understand your coverage and know the costs you must pay when visiting your physician, having tests, and undergoing procedures. University Pain Medicine Center recommends that you learn the specifics of your plan before upcoming health care visits.
You can learn more about your policy by visiting your insurance company’s Web site or contacting the member services department. The back of your insurance card should include the phone numbers and Web site addresses you’ll need.
What Does Being Out-Of-Network Mean?
Your out-of-network benefits may differ from the in-network benefits if you have a PPO (participating provider organization) plan. HMO (health maintenance organization) plans may not cover services rendered by out-of-network providers at all. It is important that you review your insurance benefits prior to beginning treatment.
The part that you are responsible for is your copay, deductible and coinsurance as per the insurance explanation of benefits (EOB) when the claim is processed. If your deductible has not yet been met, your insurance may not issue any payment and indicate that you are responsible for the entire allowed amount. If you are paid directly by the insurance, you will be responsible for turning over the payment and supplying a copy of the EOB. If the cost sharing (deductible and coinsurance) portion of the balance(s) cannot be paid in full, our trained billing staff will personally assist you on developing and implementing a payment plan.
How Can I Obtain an Estimate for My Services?
Rates vary widely depending upon your medical benefits, allowed amounts and insurance plan. We may need to speak to you directly to determine your needs once we have completed a verification of benefits.
To contact our financial counselor or a billing representative, you can call (732) 873-6868, option 8.