primary care

HAPPY NEW YEAR!!!

We are vey excited to kick off 2021 and be YOUR source for Primary and Wellness Care, AND MORE!!!

We wanted to start off with often one of the first questions we get when people are interested in coming to our practice is ‘Do you take Insurance?’ This is a great question, the answer is no, we require full payment at time of service. We will help you with the appropriate paperwork (often called a superbill) with the correct codes that, depending on your individual insurance, reimbursed for full or part of the treatment cost!

Health insurance, in our opinion, has evolved in to something that it was never meant to be. When you need an oil change in your car or your check engine light comes on or even when you need gas do you have to check with your car insurance to know where to get these services done, of course not. You are free to choose the place that is best for you, your make or model! So why would you let your health insurance dictate your health and where to go?

Insurance is there if something major happens to protect your interests. This is how all insurances are except for healthcare! Have you ever noticed that?

Here is a list of the top 4 reasons why we don’t bill insurance and why that is a benefit to you…

1. Health insurance Interferes with our relationship with patients at every level.

• Time spent with patient – As a health care provider, while our first priority is patient care. Now, we cannot ignore that this is our way of making a living as well. In order to make money in an insurance model we would have to see as many people as we can, every day and as fast as we can to build up the amount of claims we can bill to the insurance. The insurance based system is all about quantity. We base our practice on QUALITY. Because we don’t bill insurance we can spend as much time with the patient as we deem necessary and effective. We are able to spend adequate time with the patient to truly understand their needs and current condition, overall health and goals. This allows us to find the best possible treatment plan for that patient to achieve the best results. Which brings us to the next way insurance interferes with health care.

• No more waiting weeks or even MONTHS to get an appointment! We strive to see you when YOU need to be seen! We offer many options for scheduling, even off hour appointments! We decrease your time spend sitting in the waiting room and ensure your time is well spent with us!

• Limits access to treatments – Insurance companies essentially practice medicine and interfere with the provider-patient relationship by forcing providers to follow their protocols to get reimbursement. Have you ever had a medication or treatment “denied”? The insurance companies have set treatments, or formularies, that they will pay for and If the a provider doesn’t follow what they say the treatment won’t be covered! In some cases the doctors office can submit a prior authorization form to attempt to get things covered but this requires extensive paperwork! Again, adding staff and more overhead!

• Limits access to testing – Insurance companies also hamper the doctors ability to run correct tests but only covering certain labs or providers even when other more advanced or basic testing is needed to best make a diagnosis and decisions on a treatment plan. This cookie-cutter way of doing healthcare often leaves problems unnoticed or undertreated.

• Reduces a patient to a series of numbers and codes – The insurance world is based on doctors having the right numbers and codes that line up with the numbers and codes that the insurance companies want. Basically everyone who has a certain number applied to them gets the same treatment as anyone else. A practice working in the insurance system must focus on what numbers and codes to apply to their patient to fit in the system rather than actually focusing on the patient! In fact, most offices have a dedicated employee to ensure the office gets paid and claims are processed!

• Slows the progress patients can make – Because patients are stuck with the limitations from their insurance, unless they are willing to invest in their health outside of their health insurance they are limited in the progress they can make whether it is just in time they get to spend with the doctor, ability to find the actual root cause and the ability to get proper care and treatments.

2. Health Insurance ignores actual preventative medicine.

• Early detection tests – The tests and treatments that are covered as ‘prevention’ are really not effective or not even preventative medicine. Most early detection tests are testing too late and have not been shown to be effective at reducing the cost or occurrence of the disease. True preventative medicine happens with lifestyle and dietary education years before any issues with health arise. Insurance companies don’t reimburse a provider for these types of visits and discussions, thus again placing time restraints on the provider, leaving you as the patient to only get “treated for one issue” each visit.

• Prevention is the best medicine – The best form of healthcare is prevention. Insurance based healthcare is focused on disease care and disease maintenance. Recent numbers are showing that death rates are accelerating for PREVENTABLE illnesses, in addition to more people than ever being on medications. There is big money patients taking medications! However, though it has been shown time and time again that cardiovascular disease is the number one cause of preventable deaths in our WORLD, preventative care (such as weight loss, dietary counselling or weight loss treatments) are often not covered by insurance. Insurance is driven by REACTIVE medicine. Our focus is PROACTIVE CARE! We believe at the core of health care is addressing patient problems which can be helped with a variety of methods… not just what Insurance dictates in your care!

3. Billing insurance Increases our costs and raises our prices.

• Billing Specialist – If we were to bill insurance we would need to have an extra full time staff member who’s focus was playing the numbers game with insurance companies as mentioned above- This is 40 hours paid every week! This increases the expenses of the office meaning our costs would go up.

• Out of control health cost – With insurance not only do we need more in office staff but the insurance company needs people to review the claims. This exponential increases the amount of administrative work that needs to be done, and thus the amount of workers to address a single claim and of whom your records are shuffled through. Privacy concerns come in here. At our office, we have very little outside input on your care, treatment and/or disease processes. It is a personal and private approach to make you feel your best. No one will receive an “explanation of billing” in the mail and find out you were treated for something you don’t want anyone to know about! We have seen many patients shamed by family members for being treated for things like birth control, erectile dysfunction, STDs and a variety of other personal medical treatments.

• Dishonest billing – A system set up with numbers and codes without any true focus on patients is unfortunately an invitation to people trying to work the system. If an office or hospital know that they will only get a certain percentage back from what they bill it seems obvious that they would keep increasing their prices. But also if they find a patient who has ‘good’ insurance and they are getting high reimbursement levels they will do everything they can to recommend more treatments for that patient so they can take advantage of their insurance. I’ve seen it personally and from the experience of my patient. Or if a patients insurance will cover a certain number of visits the office will make sure that the patient is seen for all of those visits, if it is what the patient needs or not. We make it a priority to provide affordable, accessible and caring primary and wellness care, regardless of your “good” insurance or not.

4. Insurance companies don’t like alternative and/or “out of the box” treatment options.

• Reimbursement better for specialists – In the insurance world the more specialized you are the greater your payment from insurances can be. Surgeons and physicians performing procedures receive greater reimbursements than providers who treat patients non-surgically. Surgeons do surgery. Our goal is to keep you away from hospitals and sharp instruments!!!

• Treatments – One of the great excuses of insurance companies about not covering the treatment we provide is saying that they are ‘experimental’ or unproven by science. Which of course is untrue everything we do is backed by science and decades (or even centuries) of experience and case studies. One example is, This treatment bio-identical hormone therapies. There are hundreds of case studies showing the efficacy and safety of such treatments, however insurance will not cover them! Why? Follow the money! Small compounding pharmacies charge a FRACTION of what big pharma charges. It is not to say we do not follow traditional standards of care at our practice, however we help you find the best treatment options for your individualized care! sub

We are not saying go out and get rid of your insurance! We are simply providing affordable and accessible care and have YOUR health at the center of that care! YOU are always our WHY!

As mentioned above, we are happy to provide a “super bill” to submit to your insurance company. Please call of office with any questions!