Insurance

Does Ponte Vedra Spine & Pain Center accept UMR?

Yes — we are in network with UMR (self-funded employer plans). Plans differ within a carrier, so we verify your specific policy before your visit.

Check my coverage Call (904) 750-3787

How UMR works at this practice

UMR is a third-party administrator owned by UnitedHealthcare. It is worth understanding what that means, because it explains most of the surprises UMR members run into.

UMR does not usually insure you. Your employer does, and UMR administers the plan and processes the claim, generally against the UnitedHealthcare network — which is why we are in network for it. But the benefit design, the deductible, what needs prior authorisation and what is excluded are all decided by your employer's plan document, not by UMR. Two people holding UMR cards from different employers can owe completely different amounts for the same injection.

So for UMR we verify against your specific plan rather than against the carrier. Bring the card, including the group number on it.

What we bill to UMR

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 UMR 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.

UMR questions

Is Ponte Vedra Spine & Pain Center in network with UMR?
Yes. UMR administers self-funded employer plans on the UnitedHealthcare network, which we participate in. Because your benefits are set by your employer rather than by UMR, we verify your specific plan before the visit.
Why does my UMR coverage differ from a colleague's?
Because UMR administers the plan rather than underwriting it. Your employer sets the deductible, the co-insurance and the prior-authorisation rules, so two UMR cards from different employers behave differently.
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 UMR?
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