Insurance & Pricing
Insurance & Pricing
At Madison Medical, we believe exceptional care should be paired with clarity and transparency.
Healthcare coverage continues to evolve, and understanding your benefits before a visit is essential. Whether you are using commercial insurance, Medicare, workers’ compensation, auto insurance (PIP), or electing self-pay services, our team is here to guide you.
Accepted Insurance Plans
Madison Medical participates with many major insurance carriers in New Jersey, including:
-
Horizon Blue Cross Blue Shield of New Jersey
-
Aetna
-
UnitedHealthcare
-
Cigna
-
Oxford
-
AmeriHealth
-
Braven Health
-
Humana
-
Medicare
-
Select Medicare Advantage plans
-
Workers’ Compensation
-
Motor Vehicle (PIP) Insurance
Coverage may vary by provider, service, and individual plan design.
Because some insurance products operate under narrow networks or tiered structures, we strongly recommend verifying your specific benefits prior to your appointment.
Understanding Your Benefits
Your financial responsibility may include:
- Copayments
- Deductibles
- Coinsurance
- Prior authorization requirements
- Referral requirements (HMO plans)
- Out-of-network benefits
Every insurance plan is unique even within the same carrier.
Before your visit, we recommend:
- Confirming that Madison Medical and your specific provider are in-network
- Verifying whether prior authorization or referrals are required
- Understanding your deductible and whether it has been met
Our team verifies benefits as a courtesy; however, ultimate financial responsibility remains with the patient based on their plan.
Our Hybrid Care Model
Madison Medical operates under a hybrid insurance and performance-based care model.
This allows us to provide:
- Traditional insurance-covered medical services
- Advanced regenerative medicine treatments
- Performance optimization programs
- Cash-based specialty packages not typically covered by insurance
Many cutting-edge therapies particularly in regenerative medicine, biologics, performance recovery, and longevity are not covered by insurance carriers.
We believe patients deserve access to innovation without compromise.
Regenerative Medicine & Performance Services
Certain services may be considered elective, investigational, or not covered by insurance, including but not limited to:
- PRP (Platelet-Rich Plasma)
- BMAC (Bone Marrow Aspirate Concentrate)
- Shockwave / EPAT therapy
- Peptide therapy
- Hormone optimization programs (TRT/HRT)
- Advanced joint preservation injections
- IV performance & recovery therapies
- Biologic treatments
For these services, we offer:
- Transparent self-pay pricing
- Bundled care packages
- Structured treatment plans
- Performance recovery programs
- Membership-based models (where applicable)
Our team will clearly outline:
- Insurance-covered components
- Non-covered services
- Out-of-pocket investment
- Available package options
We prioritize full transparency so you can make informed decisions.
Self-Pay & Cash Packages
For patients without insurance or those seeking services not covered by insurance, we offer structured self-pay options.
These may include:
- Orthopedic evaluations
- Regenerative injection packages
- Athletic recovery programs
- Hormone optimization programs
- Weight management programs
- Functional medicine evaluations
- Imaging services (where applicable)
We also provide bundled pricing for multi-session treatment plans to optimize clinical outcomes.
Pricing Estimates & Good Faith Estimates
We are committed to pricing transparency.
If you are uninsured or choosing not to use insurance, you may request a Good Faith Estimate of expected charges in accordance with federal regulations.
To request an estimate, please provide:
- Full name
- Date of birth
- Insurance carrier and plan (if applicable)
- Procedure or service requested
- CPT code (if available)
- Contact phone number and email
You will receive a response within three business days.
Please note: Final costs may vary depending on medical necessity, additional services required, or insurance processing determinations.
More Information
Medicare
Madison Medical accepts:
- Traditional Medicare
- Select Medicare Advantage plans (varies by contract)
If you are turning 65 or evaluating your Medicare options, we recommend:
- Visiting Medicare.gov
- Calling 1-800-MEDICARE
- Consulting a licensed Medicare advisor
We do not participate with every Medicare plan available in New Jersey. Plan participation is subject to contract status and renewal.
Please contact our office to confirm your specific plan.
Motor Vehicle & Workers’ Compensation Cases
Auto Accidents (PIP)
If you were injured in a motor vehicle accident, we work with New Jersey PIP insurance carriers. Please inform our scheduling team so we may guide you through documentation requirements.
Workers’ Compensation
We accept authorized workers’ compensation cases with proper referral and claim documentation.
Frequently Asked Questions
In-network providers have a contracted rate with your insurance carrier. Out-of-network benefits may result in higher patient responsibility depending on your plan.
- Copay: Fixed amount due at time of visit
- Deductible: Amount you must pay before insurance begins covering services
- Coinsurance: Percentage of cost you are responsible for after deductible is met
If your insurance denies a claim:
1. Contact your insurance carrier directly
2. Request written explanation of denial
3. Notify our billing team for review and assistance
Please notify us immediately to prevent claim delays or denials.
Billing Questions
For billing inquiries, statements, or insurance questions:
Billing
973-377-6700 ext. 4
Email Billing Department
Prior Authorization
973-377-6700 ext. 3
Email Prior Authorization Team
Hours: Monday – Friday, 8:30 AM – 5:30 PM
Please have your date of service and insurance information available.
Our Commitment
Madison Medical is built on:
- Clinical excellence
- Innovation in musculoskeletal and regenerative care
- Transparency in financial communication
- A patient-first philosophy
We believe that understanding your financial responsibility should be as clear as your treatment plan.
If you have questions not addressed here, our team is available to assist you.