You are financially responsible for the medical services you receive. Please review our policies below and sign the Financial Agreement Form.
Copayments for clinic visits are due at the time of service. If you are unable to make your copayment at the time of service, PrairieShore Pain Center reserves the right to reschedule your appointment until a time that you are able to make your copayment. Payment for any outstanding balance is due at your appointment.
PrairieShore Pain Center collects your payment for a procedure at the time when the procedure is scheduled. Your prepayment is based on an estimate of your expected financial responsibility. This is an estimate only. You are responsible for any unpaid balance after your insurance (if applicable) has been billed. In the event of overpayment you may request a refund and receive the monies within 30 days of the request. We reserve the right to reschedule your procedure until prepayment has been made.
Missed appointments and late arrivals
If you are more than 20 minutes late, we may reschedule your appointment. If you are more than 60 minutes late, or if you do not show up to your appointment, you will be responsible for a missed appointment fee. Missed office visit appointments are subject to a $30 charge. Missed procedure appointment is subject to a $60 charge. These charges are your responsibility and will not be billed to any insurance carrier.
Your insurance policy is a contract between you and your insurance carrier. You are ultimately responsible for payment-in-full for all medical services provided to you. Any charges not paid by your insurer will be your responsibility, except as limited by our contract (if any) with your insurance carrier.
Coverage changes and timely submission
It is your responsibility to inform us in a timely manner of any changes to your billing or insurance information. There is a time limit within which PrairieShore Pain Center must submit a claim on your behalf to your insurer. If PrairieShore Pain Center is unable to submit your claim within this period because we have not been supplied with your correct insurance information, you will be responsible for the charges.
If you do not have health insurance, or if your health insurance will not pay for services rendered by PrairieShore Pain Center, you are considered a self-pay patient. Your charges will be based on our current self-pay fee schedule (available from our front desks). Self-pay patients are expected to make payment in full at the time of service.
Benefits and authorization
Insurance plan participation
We participate in many but not all insurance plans. It is your responsibility to contact your insurance company to verify that your assigned physician participates in your plan. Out of network charges may have higher deductibles and copayments.
At PrairieShore™ Pain Center, our goal is to relieve your pain and improve your quality of life. If your primary physician has advised you to see a specialist for your pain, turn to us for help. To schedule your appointment, please contact us here or give us a call at (847) 883-0077.