Insurance & Payment Information | Shamloo Elite Spine & Pain Institute

Original Medicare

We accept Original Medicare (traditional Medicare) for eligible covered services provided by our practice.

Important: we do not accept Medicare Advantage plans. Medicare Advantage plans are private insurance plans that have their own provider networks, coverage rules, and billing requirements. Even though they carry the Medicare name, they are different from Original Medicare.

If you have a Medicare Advantage plan, please contact our office before scheduling an appointment. You may still be able to receive care at our practice as a cash-pay patient.

Commercial insurance & Medicare Advantage

We do not accept or bill:

— Medicare Advantage plans

— HMO plans

— PPO plans

— EPO plans

— Workers Compensation

— Other commercial insurance plans

If you have one of these plans, you may still receive care as a cash-pay patient. If you have a PPO or another plan with out-of-network benefits, we recommend contacting your insurance company directly to determine whether your plan may provide reimbursement for services you pay for yourself.

Cash-pay patients

Patients who do not have Original Medicare are welcome to receive care at Elite Spine & Pain Institute on a cash-pay basis.

Consultations & follow-up visits

Because pricing may change, we encourage cash-pay patients to contact our office for current consultation and follow-up pricing before scheduling. Our staff will be happy to provide the current fee for the service you are seeking.

Procedures

Procedure pricing is provided after Dr. Shamloo has evaluated you and determined which procedure, if any, is appropriate. Because there are many different procedures and treatment approaches, we do not use a single flat price — once your treatment plan is established, our office can provide a cost estimate before treatment.

Can I submit my receipt to my PPO insurance?

Yes, potentially. Although we do not participate with commercial PPO plans or bill those insurers directly, patients with PPO coverage may be able to submit their own itemized receipt to their insurance company and request reimbursement for eligible out-of-network services.

After you pay for your care, our office can provide an itemized receipt containing the information you need to submit a claim. Your insurance company — not Elite Spine & Pain Institute — determines whether your plan provides reimbursement and how much, if any, will be paid. Reimbursement may depend on:

— Whether your plan includes out-of-network benefits

— Your deductible

— Coinsurance requirements

— Your plan’s allowable amount

— Whether the service is considered a covered benefit

— Your individual plan’s exclusions or limitations

Please contact your insurance company before treatment if you want to determine whether your plan may reimburse you. We recommend asking specifically about your out-of-network benefits for the type of service you are considering.

What should I ask my insurance company?

If you have a PPO or other commercial plan and are considering receiving care on a cash basis, start with: “Do I have out-of-network benefits for physician services?” You can also ask:

— Is this type of consultation or procedure covered under my plan?

— Do I have an out-of-network deductible?

— What percentage of the allowed amount does my plan reimburse?

— Does my plan require prior authorization?

— Is there a separate out-of-network maximum?

— How do I submit a claim for services I paid for myself?

— What documentation do you require for reimbursement?

Your insurance carrier can provide the most accurate information about your individual benefits.

Patient Resources→ Locations→