Insurance

Does Ponte Vedra Spine & Pain Center accept Florida Blue?

Yes — we are in network with Florida Blue (HMO and PPO). Plans differ within a carrier, so we verify your specific policy before your visit.

Check my coverage Call (904) 750-3787

How Florida Blue works at this practice

We are in network with Florida Blue on both its HMO and PPO products, which covers most Blue Cross Blue Shield of Florida members in St. Johns and Duval counties, including plans bought on the marketplace and through an employer.

The practical difference between the two is the referral. A Florida Blue HMO generally requires your primary care physician to have a referral on file before a specialist visit is covered; a PPO generally does not. If you are on an HMO and unsure whether the referral has been sent, call us before the visit rather than after — it is the single most common reason a covered visit gets denied.

BlueCard members visiting from another state are usually processed through Florida Blue as the host plan. Bring the card and we will check it.

What we bill to Florida Blue

Under an in-network plan we bill your evaluation and the interventional work that follows it: epidural injections, medial branch and nerve blocks, sacroiliac and joint injections, radiofrequency ablation, and spinal cord and peripheral nerve stimulation. All of it is placed under live X-ray or ultrasound guidance rather than by landmark.

The conditions most often treated under this coverage: back pain, sciatica, neck pain, herniated disc, spinal stenosis, knee pain, shoulder pain, hip pain and peripheral neuropathy.

What is not billed to insurance

Two things are not billed to any plan, this one included. Regenerative treatments — platelet-rich plasma and bone marrow concentrate — are not covered by United States insurers and are quoted directly. SoftWave and MLS laser therapy are likewise usually self-pay. You are told which category your treatment falls into before it is scheduled, not after. The full picture is on insurance & cost.

Before you come in

What to bring

  • Your Florida Blue card and a photo ID.
  • A referral, if your plan requires one. Call us if you are not sure.
  • Any imaging relating to the pain — MRI, CT or X-ray.
  • Notes from prior treatment: physical therapy, injections, surgery.
  • A list of your current medications, including doses.

Not sure what your plan requires? Call (904) 750-3787 and we will check it with you.

Florida Blue questions

Is Ponte Vedra Spine & Pain Center in network with Florida Blue?
Yes. We are in network with Florida Blue / Blue Cross Blue Shield of Florida on both HMO and PPO plans. Plans differ within the carrier, so the office verifies your specific policy before your visit.
Do I need a referral for my Florida Blue plan?
Usually yes on an HMO, usually no on a PPO. Call the office and we will tell you what your plan requires before you come in.
I have Blue Cross from another state. Does that work here?
Out-of-state Blue plans are generally handled through Florida Blue as the host plan under BlueCard. Bring your card and we will verify it.
Being in network — does that mean my treatment is covered?
Not by itself. In network means we have a contract with the carrier and you are seen at your in-network benefit level. Whether a specific procedure is covered, and what you would owe, depends on your plan and sometimes on prior authorisation. The office verifies your benefits and gives you an estimate before anything is scheduled.
What if my plan is not Florida Blue?
See insurance & cost for the full list of plans we are and are not in network with. If yours is not on either list, call (904) 750-3787 — we will confirm it rather than guess.

Eliminate pain and reclaim your life.

Request an appointment with Dr. Loch, or call the office at (904) 750-3787. Most patients are seen within a week.

Request an appointment