Insurance Disclaimer Understanding Your Coverage

Transparency in Insurance & Billing

At the Center for the Functional Restoration of the Spine, we believe that navigating insurance shouldn't stand between you and exceptional spine care. We are proud to be in-network with Horizon, Amerihealth, and Aetna.

For patients whose plans are not listed, we offer concierge-level, out-of-network care at our Edison, Shrewsbury, and Toms River, NJ offices — ensuring that access to the gold standard of spine surgery is never out of reach. Our team is happy to help you understand your benefits and explore your options before your first visit.

Have questions about your specific plan? Call our office, and a member of our team will be glad to assist.

Verifying Your Coverage Working Together to Ensure Your Peace of Mind

Before embarking on your treatment journey, we are happy to help you verify your insurance coverage to gain a clear understanding of what your policy includes.

In-Network Insurance Plans Maximizing Your Benefits

Our practice maintains in-network contracts with several major insurance carriers, which means lower out-of-pocket costs and simplified billing for you. When you are treated as an in-network patient, your insurer has pre-negotiated rates with our practice, so you pay only your applicable copay, coinsurance, or deductible — never inflated out-of-network rates.

The Center for the Functional Restoration of the Spine is currently in-network with the following insurance plans:

Horizon Blue Cross Blue Shield of New Jersey

We accept most Horizon BCBS plans, including Horizon HMO, PPO, and EPO products. Horizon is one of New Jersey's largest carriers, and many patients throughout Edison, Shrewsbury, and Toms River carry Horizon coverage. Please confirm your specific plan type when scheduling.

AmeriHealth New Jersey

We proudly accept AmeriHealth insurance plans. AmeriHealth members can access our full range of services — including minimally invasive spine surgery, robotic spine surgery, microdiscectomy, laminectomy, spinal fusion, and non-surgical spine rehabilitation — at in-network rates.

Aetna

We are in-network with Aetna commercial insurance plans. If you carry Aetna coverage through your employer or a private plan, you may be eligible for in-network benefits at our Edison, Shrewsbury, and Toms River locations. Please verify your specific Aetna plan, as benefit levels vary by product.

Important: Insurance plans and coverage levels change frequently. Being listed as in-network does not guarantee that every service will be covered. We strongly recommend calling your insurance carrier directly to confirm your specific benefits before your appointment.

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Out-of-Network Insurance Plans Accessible High-Quality Care

Our practice is currently out-of-network with several carriers. This means we do not have a pre-negotiated contract with these insurers. However, being out-of-network does not necessarily mean your care will be uncovered — many plans include out-of-network benefits that may reimburse a portion of your treatment costs.

We encourage patients with the following plans to contact both their insurance carrier and our billing department to understand their out-of-network benefits before scheduling.

United Healthcare (UHC)
Cigna
MagnaCare
UMR (a UnitedHealth Group company)
EmblemHealth
QualCare
Medicaid / NJ FamilyCare
Oxford Health Plans
Oscar Health
MultiPlan / PHCS
Humana
Braven Health

If your plan appears on this list, please do not let that deter you from reaching out. Our billing team will work with you to explore your options, provide a cost estimate, and discuss self-pay or payment plan arrangements if needed. Exceptional spine care is our priority, and we will do our best to accommodate you.

Note for Medicaid patients: We are not currently enrolled as a Medicaid provider. If you are covered under NJ FamilyCare or another Medicaid-managed care program, please contact us to discuss available options.

Understanding Your Benefits Empowering You with Knowledge

We encourage you to review your policy and reach out to your insurance provider directly for detailed information about your coverage. It's important to familiarize yourself with key insurance terms such as:

Deductible

The amount you must pay out of pocket before your insurance coverage begins.

Co-Pay

A fixed fee you pay for specific medical services or prescription drugs.

Co-Insurance

Your share of the costs of a covered healthcare service, calculated as a percentage.

Out-of-Pocket Maximum/Limit

The maximum amount you will pay for covered services during a policy period.

Questions About Pre-Authorization and Referrals Navigating Pre-Treatment Requirements

Some insurance plans may require pre-authorization or referrals for certain medical services. To ensure a seamless experience, we recommend verifying with your insurance provider whether your treatment at our facility requires any pre-authorization or referral documentation. Our team is available to assist in this process and provide the necessary information to your insurer.

Billing and Payment Options Transparency and Support

We strive to maintain transparency throughout the billing process and provide comprehensive support to our patients. Our billing department is readily available to address any questions or concerns you may have regarding invoices, payment options, and insurance claims. We work diligently to ensure that you have a clear understanding of your financial responsibilities.

Contact Us for Guidance Your Trusted Resource

If you have any questions or require assistance with insurance-related matters, please don't hesitate to contact us. Our knowledgeable team is here to serve as your trusted resource, providing guidance, answering your queries, and working diligently to facilitate your access to exceptional orthopedic care.

Your Well-Being Matters Most Partnering in Your Health Journey

Your well-being remains our top priority. We understand that each patient's insurance situation is unique, and we are committed to partnering with you to find the best possible solutions.

We believe that access to high-quality orthopedic care should be within reach for all our patients, and we will continue to support you every step of the way.

We thank you for entrusting the Center for the Functional Restoration of the Spine with your orthopedic care needs and look forward to assisting you in your journey to recovery.

Insurance Q & A

Do I need a referral to see a spine specialist at your practice?

What if my insurance denies a claim or prior authorization?

Can I be seen if I have United Healthcare, Cigna, or another out-of-network plan?

Do you accept Medicare?

Do I need a referral to see a spine specialist at your practice?

It depends on your insurance plan. HMO plans typically require a referral from your primary care physician, while PPO and EPO plans often allow direct specialist access. Check with your carrier to confirm whether a referral is required before scheduling.

What if my insurance denies a claim or prior authorization?

Denials can be appealed. Our team will work with you and your insurer to provide any additional clinical information needed to support the medical necessity of your treatment. We are experienced in the appeals process and will advocate on your behalf.

Can I be seen if I have United Healthcare, Cigna, or another out-of-network plan?

Yes. While we are currently out-of-network with United Healthcare, Cigna, MagnaCare, UMR, EmblemHealth, QualCare, Oxford, Oscar Health, MultiPlan, Humana, and Braven Health, patients with these plans are still welcome at our practice. We will provide a good-faith cost estimate and help you understand your out-of-network reimbursement options.

Do you accept Medicare?

Please contact our office directly for the most current information regarding Medicare participation status.

Dr. Paragioudakis examining patient's arm

Ready to Schedule? Let Us Help.

Don't let insurance questions delay the care you deserve. Whether you are a Horizon, AmeriHealth, or Aetna member looking to use your in-network benefits, or a patient with an out-of-network plan exploring your options, our team is here to guide you every step of the way.

Our spine specialists serve patients across Edison, NJ, Shrewsbury, NJ, and Toms River, NJ, offering advanced treatments including minimally invasive spine surgery, robotic spine surgery, microdiscectomy, herniated disc surgery, spinal fusion, laminectomy, disc replacement, endoscopic decompression, and comprehensive spine rehabilitation.

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Disclaimer: Insurance participation, plan coverage, and benefit levels are subject to change. The information on this page is provided for general guidance only and does not constitute a guarantee of coverage or payment. Patients are responsible for verifying their individual plan benefits directly with their insurance carrier prior to receiving services. The Center for the Functional Restoration of the Spine is not responsible for any benefits determination made by your insurer. All billing and coverage questions should be directed to your insurance carrier and our billing department.

Insurance Disclaimer Understanding Your Coverage

Transparency in Insurance & Billing

Verifying Your Coverage Working Together to Ensure Your Peace of Mind

In-Network Insurance Plans Maximizing Your Benefits