Increasing access to care and affordability for our patient population

Insurance & Pricing

At PRM, we are proud to be in-network providers with Blue Cross Blue Shield in most locations. PRM participates with most major health insurance plans as non-par providers.

Check Your Coverage

The Way Pelvic Pain Patients Should Be Treated

What Makes PRM Different?

At PRM, we know the average patient spends $29,951 on in-network treatments, diagnostics, and surgeries that provide minimal sustained relief. With that in mind, at the core of our mission is providing patients with affordable access to the care they deserve.

We take the time to make sure you get the whole picture.

Our team spends time with you and your insurance to understand your benefits, verify what coverage is available to you, and work to find pricing that fits your plan.

If cost is a barrier, we have options.

We are not interested in increasing the financial burden on pelvic pain patients. PRM is proud to offer payment plans pre and post-treatment to reduce the financial burden on our patients.

We have a dedicated benefits team.

For patients who are using their insurance, we have a dedicated team that will work tirelessly to advocate on your behalf to your insurance company.

We will advocate for you.

At the core value of our mission, we are striving every day to continue to advocate and educate the insurance industry on the burden of pelvic pain and increase awareness of the need for enhanced coverage and access to care for patients.

We offer financing options.

At PRM, we understand that receiving the necessary care or treatment may sometimes come with a financial burden. That’s why we are proud to offer CareCredit financing, a convenient and flexible payment solution that allows you to prioritize your health without delay.

Get Information on Financing

Check Your Insurance Coverage

Select your state, then your insurance carrier, for an answer specific to your situation.

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What state are you in?

What's your insurance carrier?

Full Insurance Details by State

Prefer to just read everything? All states are listed below in full.

California
BlueCross BlueShield – In-network
Cigna – if coverage includes out-of-network benefits
United Health Care – if coverage includes out-of-network benefits
Aetna – if coverage includes out-of-network benefits
*If your insurance carrier is not listed above but your insurance plan does have out-of-network coverage, we will work with your plan.
CareCredit Financing – Apply now to see if you prequalify!
Florida
BlueCross BlueShield – In-network
Cigna – if coverage includes out-of-network benefits
United Health Care – if coverage includes out-of-network benefits
Aetna – if coverage includes out-of-network benefits
*If your insurance carrier is not listed above but your insurance plan does have out-of-network coverage, we will work with your plan.
CareCredit Financing – Apply now to see if you prequalify!
Georgia
BlueCross BlueShield – In-network
Cigna – if coverage includes out-of-network benefits
United Health Care – if coverage includes out-of-network benefits
Aetna – if coverage includes out-of-network benefits
*If your insurance carrier is not listed above but your insurance plan does have out-of-network coverage, we will work with your plan.
CareCredit Financing – Apply now to see if you prequalify!
Illinois
BlueCross BlueShield – In-network
Cigna – if coverage includes out-of-network benefits
United Health Care – if coverage includes out-of-network benefits
Aetna – if coverage includes out-of-network benefits
*If your insurance carrier is not listed above but your insurance plan does have out-of-network coverage, we will work with your plan.
CareCredit Financing – Apply now to see if you prequalify!
Maryland
BlueCross BlueShield – In-network
CareFirst – In-network
Cigna – if coverage includes out-of-network benefits
United Health Care – if coverage includes out-of-network benefits
Aetna – if coverage includes out-of-network benefits
*If your insurance carrier is not listed above but your insurance plan does have out-of-network coverage, we will work with your plan.
CareCredit Financing – Apply now to see if you prequalify!
Michigan
BlueCross BlueShield – In-network
Cigna – if coverage includes out-of-network benefits
Blue Care Network of Michigan – In-network
Priority Health – In-network
United Health Care – if coverage includes out-of-network benefits
Aetna – if coverage includes out-of-network benefits
*If your insurance carrier is not listed above but your insurance plan does have out-of-network coverage, we will work with your plan.
CareCredit Financing – Apply now to see if you prequalify!
New Jersey
BlueCross BlueShield – if coverage includes out-of-network benefits
Cigna – if coverage includes out-of-network benefits
United Health Care – if coverage includes out-of-network benefits
Aetna – if coverage includes out-of-network benefits
*If your insurance carrier is not listed above but your insurance plan does have out-of-network coverage, we will work with your plan.
CareCredit Financing – Apply now to see if you prequalify!
New York
BlueCross BlueShield – if coverage includes out-of-network benefits
Cigna – if coverage includes out-of-network benefits
United Health Care – if coverage includes out-of-network benefits
Aetna – if coverage includes out-of-network benefits
*If your insurance carrier is not listed above but your insurance plan does have out-of-network coverage, we will work with your plan.
CareCredit Financing – Apply now to see if you prequalify!
Tennessee
BlueCross BlueShield – In-network
*If your insurance carrier is not listed above but your insurance plan does have out-of-network coverage, we will work with your plan.
CareCredit Financing – Apply now to see if you prequalify!
Texas
BlueCross BlueShield – In-network
Cigna – if coverage includes out-of-network benefits
United Health Care – if coverage includes out-of-network benefits
Aetna – if coverage includes out-of-network benefits
*If your insurance carrier is not listed above but your insurance plan does have out-of-network coverage, we will work with your plan.
CareCredit Financing – Apply now to see if you prequalify!
Virginia
BlueCross BlueShield – In-network
CareFirst – In-network
Anthem – In-network
Cigna – if coverage includes out-of-network benefits
United Health Care – if coverage includes out-of-network benefits
Aetna – if coverage includes out-of-network benefits
*If your insurance carrier is not listed above but your insurance plan does have out-of-network coverage, we will work with your plan.
CareCredit Financing – Apply now to see if you prequalify!

We Provide In-Network & Out-of-Network Options for Patients

At Pelvic Rehabilitation Medicine, we are on a mission to provide access to care to every patient. We believe the cost of comprehensive care should not be a burden for patients seeking diagnosis and treatment that ensures a full and complete, pain-free life. Learn more about our insurance coverage.

BlueCross BlueShield
CareFirst
Anthem
Cigna
Blue Care Network of Michigan
Priority Health
United Health Care
Aetna
CareCredit
Now Available: Real-Time Insurance Verification and CareCredit Financing

The Burden of Chronic Pelvic Pain: The Cost Burden

Chronic pelvic pain can seriously affect the lives of both men and women, as it can be caused by gynecologic, urologic, gastrointestinal, and musculoskeletal conditions. This can affect one’s ability to rest, have intercourse, go to work, and any other daily life activities. A study that included research by Pelvic Rehabilitation Medicine determined that the cost for those who seek and receive treatments for chronic pelvic pain is well into the tens of thousands of dollars, often for treatments that provide limited sustained relief. Most interestingly, the economic burden associated with endometriosis was estimated to be $69.4 billion by analyzing 12 tertiary centers in 10 European Countries.

$29,951
Cost of Diagnosis & Treatment (w/o PRM)
~5x Less
Cost of Diagnosis & Treatment with PRM

Common Insurance Questions

What if I have out-of-network benefits and I want to be self-pay?

You can decide to go self-pay. We will honor that decision, but you have to decide upfront and maintain that decision for the duration of your treatment.

What if I need a prior authorization?

We will move forward with the new patient appointment and once we receive the clinical note from your new patient appointment, we will work to obtain the prior authorization and can move forward with your treatment.

What if I need a referral to be seen?

We will work with you to contact your PCP and provide any needed information to administer the referral.

Will you give me an itemized receipt to submit my own claims?

No, sadly at this time we are unable to do that.

Will you bill my insurance for me?

Yes, we will absolutely bill your insurance for you.

What does co-insurance mean?

Co-insurance is a percentage a patient and their insurance company agree upon for payment. What this means is if a patient has a 20% coinsurance and their insurance allows $100 for the visit, the insurance will only pay $80 and the patient will be responsible for $20.

What does out-of-network mean and how do I know if I have out-of-network benefits?

OON means that your provider has not been contracted with your insurance and has not agreed upon a set payment schedule from the insurance.

OON members may incur higher out-of-pocket costs and providers have the ability to balance bill members over any set cost share (deductible, copayment, coinsurance) the insurance deems their responsibility.

In order to know if a patient’s insurance plan carries OON benefits either the patient or the providers’ office will need to call the patient’s plan and do a benefit verification.

Also, a patient would choose a plan at the time of enrollment with their employer or insurance agency that either does or does not have OON benefits. Usually plans with OON benefits have a higher premium to the member.

What is a deductible and how do I know if I have met it?

A deductible is a set amount that the patient and insurance agreed upon at the time of enrollment. The higher the deductible, the lower the premium the patient pays to the insurance. Each year the deductible resets on the yearly date for the plan, usually in January for most patients.

The way the deductible works is your insurance plan will process your claim with an allowed amount and will apply whatever they allow and would have paid the provider to the patient’s deductible and the provider will not get paid and needs to collect that amount from the patient.

The providers are legally obligated to collect these amounts from both their in-network and out-of-network patients. The only way to know how much has been met is for the provider or patient to contact the insurance company and request the amount the patient still owes.

What is an EOB?

An EOB is an explanation of benefits. After the provider submits the claim to the insurance, the insurance processes the claim and sends an explanation of benefits to both the provider and patient.

This explanation shows exactly how the insurance processes the claim they received from the provider. It will show the charges, their allowed amount for each procedure or CPT done, what the patient is responsible for (copay, co-in, and deductible), and what if any was paid to the provider. OON patients EOB’s will state they are responsible for the full amount of charges because the provider does not have a contract with the insurance.

The following codes will be present on the EOB to represent the patients’ cost share responsibility, which represents what the provider must bill for.

PR-1 – Deductible
PR-2 – Co-insurance
PR-3– Copayment

The following may also appear on the EOB – this will show the balance bill amount the patient may be charged for

PR-242 – services not provided by an in-network provider

Where can I learn more information about common health insurance terms to better understand my bill?

We always recommend patients check out the <a href=”https://www.cms.gov/files/document/nosurpriseactfactsheet-health-insurance-terms-you-should-know508c.pdf”>No Surprises Act</a> terms sheet. Of course, we are always available to help patients understand their bills or EOB.

Does PRM offer financing?

Yes. At PRM, we understand that receiving the necessary care or treatment may sometimes come with a financial burden. That’s why we are proud to offer CareCredit financing. PRM patients can simply visit the <a href=”https://www.carecredit.com/go/537HXH/”>CareCredit website</a> to learn more about pre-approval or give us a call, and our team at PRM will guide you through the process. Patients may use CareCredit to help pay for deductibles and out-of-pocket expenses not covered by insurance.

Why does PRM collect payment up front at the time of scheduling?

Please note that when scheduling your appointment, our team will collect a $50 payment upfront for OON and self-pay patients. If you are in-network, we will collect your co-pay. This is because we want you to come into the office and just be seen. We don’t want patients to have to worry about filling out paperwork, fiddling with their insurance, payments, and more. We want you to be 100% focused on getting treatment and talking with the provider about their care plan. Should you need to cancel within 24 hours or reschedule, this is fully refundable, and the fee does go towards the cost of your visit.

Will you verify my insurance before my visit?

Yes. Our team works hard to ensure your visit is about your treatment and nothing else. Our team spends time with you and your insurance to understand your benefits, verify what coverage is available to you, and work to find pricing that fits your plan. At the time of schedule, we will work to verify your benefits and explain to you your benefits.

Why doesn't PRM take my insurance?

We truly work with all insurances, as long as your plan offers OON benefits. At PRM, we are proud to be in-network providers with Blue Cross Blue Shield in most locations. We do know that not everyone has BCBS, which is why additionally, PRM participates with most major health insurance plans as non-par providers. Your out-of-pocket payment will vary according to the specifics of your plan and services but we do offer competitive self-pay rates as well.

Why are you only able to accept OON unless I have BCBS?

Due the quality of care that we provide and the time that we spend with our patients, being out of network is the only way that we can provide our services without losing the time and quality of care that our patients deserve. However, we are constantly striving to provide access to care to more patients through more insurance providers, as it is a mission of our founders.

What is the maximum I can owe as an OON patient?

Your maximum responsibility for your new patient visit can be up to the total billed amount of $250.00 which you would have already paid $50.00.

How will I know my co-pay as an in-network patient?

We are considered an in network specialist with BCBS which means you would be responsible for your specialist copay. However, Just to be sure an office coordinator will be verifying your benefits and reaching out to you to discuss your coverage and financial responsibility prior to you coming in for your appointment.

The Only Way to Treat Pelvic Pain is Here

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