Are you planning on using your motor vehicle accident insurance? Here is what you need to know:

  • We DO NOT take liens.
  • The motor vehicle insurance used to pay for your medical claims at Spine West must be your own.
  • If your motor vehicle insurance declines to pay for your medical bills, it becomes patient responsibility.

Insurance & Billing

Spine West, LLC accepts most insurance plans. We ask that you please call your insurance company to verify individual coverage.

For questions about billing, please call (303) 494-7773 x 111
Email: billing@spinewest.com

Patients can check their latest statement and pay it online via the patient portal. Please check if your insurance plan requires a referral to see us.

The following list shows which major insurances we accept.

Please take note of items in red as they are plans we have identified as not being in network, or they require referrals:

  • AARP United Healthcare Medicare Complete
  • Aetna
  • Aetna EPO, Elect Choice, HMO or Medicare HMOrequires that your PCP(Primary care doctor) submits a referral to Aetna with CPT code 99499 before we see you.
  • Aetna Medicare PPO
  • Assurant
  • Blue Cross Blue Shield
  • Blue Cross Blue Shield Federal Employees Program
  • Cigna
  • Cigna Connect – requires that your PCP submits a referral to Cigna before we see you.
  • Cigna Local Plus, Vantage, SureFit – Not In Network
  • Cofinity
  • GEHA(United Integrated Services)
  • Golden Rule
  • Golden Rule Navigate – requires an online referral from PCP. Must be done through United Healthcare website.
  • Humana
  • Humana Medicare
  • Medicare
  • UMR
  • United Healthcare
  • United Healthcare Navigate or Compass – requires an online referral from PCP. Must be done through United Healthcare website.

How does medical billing work?

At Spine West, we want our patients to understand how medical billing works. Therefore, it is important to understand what the following terms mean. These are terms you will often see when your insurance company sends you an explanation of benefits (EOB).

Charged amount – The charged amount is the standard amount we charge your insurance for a particular service. Depending on what was done or performed, this can vary. Keep in mind the amount we charge an insurance company for a particular service is the same for all insurance companies. (example: We charge Aetna, United Healthcare, Blue Cross Blue Shield the same amount for an MRI which is $1,000)

Allowed amount – The allowed amount is the contracted rate your insurance company allows for that particular service or procedure. The allowed amount is really what is important. (example: Although we charged United Healthcare and Blue Cross Blue Shield $1,000 for an MRI, United Healthcare will allow typically $610 and Blue Cross Blue Shield allows $575)

Adjustment or discount – This is the amount by which a medical claim was “adjusted” or “discounted” by your insurance company. This is charged amountallowed amount. (example: If you have Blue Cross Blue Shield, for an MRI, charged amount $1,000 – allowed amount $575 = adjustment of $425). In essence, the adjustment or discount is by how much the charged amount was reduced by for having that particular insurance.

Deductible – This is the amount you agreed to pay for your health care services every year before your insurance starts to pay. (example: If you have a $3,000 deductible every year with your insurance company, then you pay the first $3,000 of covered services)

Copay – This is a fixed amount you pay as dictated by your insurance plan. Copays are usually required after you’ve met your deductible and are always due at the time of service.

Co-insurance – The percentage of costs you share with your insurance company after the deductible is met. (example: If you have a plan that stipulates you will have a 20% coinsurance after your deductible is met then you are responsible for paying 20% of the allowed amount for any claim)

For more information on these terms visit HealthCare.gov.

Example Scenarios

Scenario 1

Your insurance plan has a $2,000 deductible of which you have not paid any towards for the year.

You are coming in for an MRI.

Although we charge $1,000 to your insurance, the insurance’s allowable rate for an MRI at Spine West is $600.

$400 is adjusted or discounted off the charged amount.

You will be responsible for paying the $600.

Scenario 2

Your insurance plan has a $2,000 deductible of which you have paid for the year. You DO NOT have a copay or coinsurance.

You are coming in for an MRI.

Although we charge $1,000 to your insurance, your insurance’s allowable rate for an MRI at Spine West is $600.

$400 is adjusted or discounted off the charged amount.

Your insurance will pay the $600.

Scenario 3

Your insurance plan has a $2,000 deductible of which you have paid for the year. You have a plan in which you have a 20% coinsurance.

You are coming in for an MRI.

Although we charge $1,000 to your insurance, your insurance’s allowable rate for an MRI at Spine West is $600.

$400 is adjusted or discounted off the charged amount.

Your insurance will pay $480, or 80%.

You will have to pay $120, or 20%.