Healthcare billing can sometimes be difficult to understand. Between deductibles, copays, coinsurance, prior authorization, and insurance network requirements, patients may not always know what their medical care will cost.
A cash-pay medical practice uses a different model.
What Does “Cash Pay” Mean?
In a cash-pay practice, the patient pays the clinic directly for services rather than having the clinic bill an insurance company for the office visit. “Cash pay” describes the clinic’s payment model; it does not necessarily mean paper currency.
Contact the office for current information about accepted forms of payment and pricing.
Why Do Some Medical Practices Use a Cash-Pay Model?
A cash-pay structure can make the financial side of an office visit easier to understand because patients can be told the clinic’s charges without waiting for an insurance company to determine a deductible, copay, coinsurance amount, or claim outcome.
However, patients should not assume that cash-pay care is automatically less expensive than using insurance. The best option depends on the individual patient’s healthcare coverage and circumstances.
Does Cash Pay Mean You Can Schedule Without a Referral?
No. Payment and clinical requirements are separate. New patients need:
- An established chronic pain diagnosis
- A referral from a medical provider
Does Cash Pay Mean Medication Is Automatically Prescribed?
No. Paying for an appointment does not guarantee that any particular medication, procedure, or treatment will be prescribed.
Treatment decisions are based on the provider’s medical evaluation, diagnosis, patient history, relevant records, examination, and clinical judgment. Pain management care may involve different approaches depending on the individual patient’s condition.
What Should New Patients Expect?
Patients should be prepared to provide relevant records and an accurate medication history.
During pain management care, the provider may review the patient’s diagnosis, previous treatment, current symptoms, medications, and functional limitations. Additional monitoring may also be part of chronic pain care when medically appropriate.
What About Insurance Reimbursement?
Restore does not accept or bill insurance. All services are provided on a cash-pay basis.
Restore can provide a superbill that patients may submit directly to their insurance company for possible reimbursement.
Reimbursement is not guaranteed and varies by plan. Patients should contact their insurance carrier directly to ask about any available out-of-network benefits.
The cash-pay model does not change the clinic’s clinical standards. If you believe specialized pain management may be appropriate, talk with your current healthcare provider about your symptoms and whether a referral is appropriate.