Insurance

Does Ponte Vedra Spine & Pain Center accept Medicare?

Yes — we are in network with Medicare (Traditional Medicare, Medicare Advantage and AARP Medicare plans). Plans differ within a carrier, so we verify your specific policy before your visit.

Check my coverage Call (904) 750-3787

How Medicare works at this practice

We are in network with traditional Medicare and with Medicare Advantage plans, including the AARP Medicare plans administered by UnitedHealthcare.

Interventional pain treatment is squarely within what Medicare covers, and Medicare's rules for it are more specific than most commercial plans. Radiofrequency ablation, for instance, generally requires two diagnostic medial branch blocks with a documented response before the ablation itself is covered. That is not us being cautious — it is the coverage rule, and it is a large part of why a plan here often starts with a diagnostic step rather than the treatment.

Medicare Part B typically leaves you responsible for a share of the cost. A supplement, including AARP Medicare supplement plans, usually picks that up. Bring both cards.

What we bill to Medicare

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 Medicare 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.

Medicare questions

Does Ponte Vedra Spine & Pain Center accept Medicare?
Yes. We are in network with traditional Medicare and with Medicare Advantage, including AARP Medicare plans. Bring your Medicare card and any supplement or Advantage card so the office can verify both.
Why does Medicare require blocks before an ablation?
Medicare coverage rules generally require two diagnostic medial branch blocks with a documented response before radiofrequency ablation is covered. It is a coverage requirement, and it also happens to be the way to confirm the right nerves are being treated.
I have a Medicare Advantage plan. Do you take that?
Yes. We are in network with Medicare Advantage as well as traditional Medicare. Advantage plans are run by private carriers and each sets its own referral and authorisation rules, so call the office with your card and we will confirm how your specific plan works before you book.
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 Medicare?
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