Health Insurance Information for Patients

Just like each patient is different, insurance plans can be varied and offer differing benefits. At Englewood Spine Associates, our goal is to work with every patient and insurance plan to provide individualized medical care that improves your quality of life and function. Our goal is to get you back to doing things that you want to do as fast as possible.

Please call us at (201) 608-5656 to speak with one of our experienced spine patient advocates with any questions you may have regarding your insurance benefits.

Our providers are out-of-network with most insurance carriers. What does that mean?

  1. Out-of-network means the physician has chosen not to enter into a contract with the insurance carrier.
  2. Typically, physicians that are in-network are willing to accept a lower fee from the insurance carrier in exchange for access to a larger volume of patients.
  3. By reducing the number of patients that they see, out-of-network physicians and their staff can dedicate more time and attention to every patient
  4. Patients seeing an out-of-network provider typically have insurance with out-of-network benefits.
  5. Similar to in-network benefits, out-of-network benefits may have deductibles, co-insurance, and annual maximum out-of-pocket amounts.
  6. At Englewood Spine Associates, we understand your concerns and do our best to assist you to receive the appropriate payment from your insurance carrier. Our patient advocates will explain and walk you through the process so that there are no financial surprises.

These are some key points why going out-of-network can be a better option for surgery:

  1. Given the complexity of spinal surgery, ESA has chosen to be out-of-network, so that they can spend more time with you.
  2. Englewood Spine Associates is an independent practice that is not owned by any large entity. In many cases, large corporations put time and productivity pressures on their doctors.
  3. Our ESA physicians are highly conservative by nature and being independent and out-of-network allows us to be extremely selective about when we tell our patients that surgery is necessary. Our physicians frequently steer patients away from surgery that was recommended by other surgeons if our physicians believe the surgery is not in your best interest.
  4. Out-of-network practices such as ESA are considered “concierge practices” that cater to the patients’ specific needs since in-network physicians cannot afford to spend as much time with each patient due to higher patient volume.
  5. As a result of lower patient volume, ESA office appointments and surgeries can frequently be scheduled sooner and more conveniently.
  6. Going out of network also allows patients to have easier access to our ESA staff and physicians. While we have a dedicated team of physician assistants and medical assistants, you will normally see a physician when you come to the ESA office.

Medicare – We participate with Standard Medicare. 

Medicaid – We do not participate with Medicaid

Telehealth – ESA also offers virtual telehealth services, using high-definition video and audio technology. Our telemedicine service provides patients realtime, twoway communication via secure online virtual sessions. Telehealth is now covered by most insurances.

Workers Compensation – Our physicians also work with several workers’ compensation carriers, including MCOs (managed care organizations). Please reach out to one of our patient advocates at (201) 608-5656 to see if our physicians participate in your policy. Our patient advocate will then contact your adjuster to determine if an appointment can be made.

Auto insurance (PIP) – Our physicians participate with many PIP plans. Please reach out to one of our patient advocates at (201) 608-5656 who will then contact your adjuster to determine if an appointment can be made.