Get Clarity on Your Pain Care Coverage

Approval some insurers require before they pay for a procedure, imaging, a device or a medicine. It is a rule of your plan, not of the clinic.

1. The clinic submits the request with your notes, imaging and the reason the treatment is needed. For medicines, SEVA Healthcare handles prior authorizations by fax with the pharmacy or insurer.
2. The insurer responds: approved, more information needed, or denied. Urgent requests are usually faster.
3. Ask what was approved. An approval can be limited to a number of visits, a procedure code or a date range.

Tip: if a procedure is scheduled, ask whether authorization has come back before you take time off work or arrange a driver.

1. Get the reason in writing. Many denials are administrative: a missing record, a wrong code, or a step your plan wanted first.
2. Use the internal appeal. Every plan has one, with a deadline on the denial letter. The clinic can add a medical-necessity letter and your records.
3. Ask for external review. If the internal appeal fails, most plans must offer an independent review. Your state insurance department can explain how.
4. Keep copies of letters, dates and the names of people you spoke to.

• Good-faith estimate: if you are uninsured or paying yourself, you have the right to a written estimate before scheduled care.
• Surprise-billing protection: federal rules limit unexpected out-of-network bills for emergency care and certain services at in-network facilities.
• Itemized bills: you can ask for one, and question any line you do not recognise.

SEVA Healthcare links its good-faith estimate, surprise-billing and billing-rights notices from the footer of sevahealthcare.com.

Care after a crash may be paid by auto insurance (yours or the other driver’s), health insurance, or through an attorney.

• SEVA Healthcare states that it works with attorneys and insurance carriers for accident patients in Tulsa, Dallas and New Mexico.
• Bring your claim number and any attorney details to the first visit.
• Read why seeing a doctor should come before calling a lawyer.

• Your employer’s workers’ comp insurer usually pays for care, and treatment often needs the insurer’s authorization first.
• Bring your claim number, the adjuster’s contact details and any employer paperwork.
• SEVA Healthcare says it works with every major workers’ comp carrier across its three states.

• Medicare: Original Medicare and Medicare Advantage plans are listed.
• Medicaid: SoonerCare (Oklahoma), Texas STAR and Turquoise Care (New Mexico).
• Government plans have their own prior-authorization and referral rules, so ask the clinic to confirm your plan before the first visit.