Yes. Medicare covers pain management consultations, follow-up visits and most injections when they are medically necessary and documented. So do Medicare Advantage, Aetna, Blue Cross Blue Shield and Cigna, which are the plans AffordaHealth is in network with at both clinics. The differences between plans show up in three places: whether you need a referral, whether a procedure needs prior authorization, and how often a treatment can be repeated. Our front desk checks all three before you come in.
What is usually covered
- Consultations and follow-up visits for pain management, neurology and addiction medicine, covered as specialist office visits.
- Trigger point and joint injections, covered when medically necessary, with limits on how often they can be repeated.
- Nerve blocks, covered when medically necessary. Medicare's rules for chronic pain blocks are under review, so authorization is common.
- Knee gel injections, covered by Medicare when a weight-bearing X-ray shows osteoarthritis and at least three months of conservative care are documented. Some commercial plans do not cover them.
- Botox for chronic migraine, covered when the criteria are met: 15 or more headache days a month and failed oral preventives. Every payer requires prior authorization.
- Medication-assisted treatment visits and generic buprenorphine. Brand products and Vivitrol usually need prior authorization.
What is not covered
PRP injections and StemWave shockwave therapy are cash services that no insurer covers. IV vitamin infusions are self-pay wellness services. Weight loss medication coverage varies widely: some commercial plans cover Zepbound or Wegovy with prior authorization, most cover Mounjaro and Ozempic for type 2 diabetes, and Medicare does not cover them for weight loss alone. We tell you which applies to your plan before you decide anything. Our insurance and self-pay page has the full table.
Referrals and prior authorization
Many Medicare Advantage and HMO plans require a referral from your primary care doctor before a specialist visit, and prior authorization for injections, nerve blocks, Botox and Vivitrol. We request these for you. Authorization can add a few days before a procedure, so we start the paperwork early, usually at the first visit once the doctor has decided on the plan.
Workers' compensation and auto injury
If you were hurt at work, your employer's insurance carrier authorizes care and the treating physician's records determine what is approved. If you were hurt in a car accident in Florida, your own auto policy's personal injury protection (PIP) pays first. We treat both at Davie and Boynton Beach and handle the documentation with the adjuster or attorney. The work and auto injury page explains the process.
Medicaid and self-pay
We are not in network with Medicaid. Medicaid patients are welcome as self-pay, and the front desk explains the cost of a new patient visit on the phone before anything is booked. Self-pay is available for any service.
How to find out what your plan covers
Book an appointment online or call either clinic, and tell us your plan. The front desk confirms whether we are in network, whether you need a referral, and what your visit will cost, before you come in. Networks change, so we check every time rather than relying on a list.
Questions patients ask
Does Medicare cover nerve blocks for chronic pain?
Nerve blocks are covered when medically necessary. Medicare's rules for chronic pain blocks are under review, so prior authorization is often needed. AffordaHealth requests it for you.
Do I need a referral to see a pain management doctor?
On many Medicare Advantage and HMO plans, yes, from your primary care doctor. Original Medicare and most PPO plans do not require one. The front desk checks your plan before your first visit.
Which insurance does AffordaHealth accept?
Medicare, Medicare Advantage, Aetna, Blue Cross Blue Shield and Cigna at both the Davie and Boynton Beach clinics, plus workers' compensation and Florida auto injury (PIP) claims. Self-pay is available. Medicaid is not accepted in network.
What pain treatments are cash only?
PRP injections and StemWave shockwave therapy (Davie only) are not covered by any insurer. IV vitamin infusions are self-pay. Everything else is billed to insurance where covered.