Insurance and Fees

Insurance Questions

Healthcare in the United States is changing for many of us. More people are obtaining insurance due to the Affordable Care Act or are changing their policy due to a change in rates.  For more information about the Affordable Care Act, please follow this link.

We often get questions related to insurance because we are different from the standard medical office.  To help you in your decisions and to obtain the maximum reimbursement possible we have compiled a list of frequently asked questions below

Click on the link or scroll down for the answer.

 

Frequently Asked Insurance Questions:

  1. Does Family to Family take insurance?
  2. How do I seek reimbursement from my insurance company?
  3. How much will I be reimbursed?
  4. Do you take Medicare?
  5. What if I have Medicare and a secondary commercial insurance – can I submit receipts to my secondary insurance company?
  6. Do you take Medicaid?
  7. Are there any insurance companies that reimburse at a higher rate for your services?
  8. Can I bill my labs through insurance?
  9. How much do you charge for your services?
  10. Do you take CareCredit?

 

 

1.  Does Family to Family take insurance?

The doctors at Family to Family are committed to providing comprehensive integrative and holistic medical care for our patients so we have chosen to remain out-of-network providers for insurance. This means we do not contract with insurance companies, and thus, we cannot bill insurance.

If we were to contract with insurance companies beyond this list, we would not be able to spend the amount of time with each patient to provide the high quality of care we currently provide.  We believe you and your doctor choose how much time you need, rather than your insurance company.

Many family practitioners must see many patients in a day before they begin to break even so they have a huge incentive to fit more patients into a day.  Thus, appointments are shorter – on average, 15-18 minutes according to statistics.1   We don’t do that.

Instead, we take time to listen deeply so we understand every patient and address the root cause of every concern with a comprehensive plan tailored to your needs.

Think of it this way: Taking insurance would negatively impact the very qualities you are seeking in our practice.

We DO accept:

  • Health Savings Accounts,
  • Dr. Bradt accepts  Medicaid ONLY for newborns, infants and children and on a limited basis. Please contact us by phone or email to see if we have availability and if you meet the criteria for acceptance into the practice.


2.How do I seek reimbursement from my insurance company?

We will provide you with an insurance-ready receipt at the time of checkout that you can submit to your insurance company for potential reimbursement. This receipt will have the appropriate billing and diagnosis codes needed to file with your insurance company.

Please remember that we are an out-of-network provider so you will need to check with your insurance company to see if you have out-of-network benefits before submitting these forms to them.  You must have out-of-network benefits to seek reimbursement for them.

There may be an additional form for out-of-network filing you will need to obtain from your insurance company that you will submit with our insurance-ready receipt.  The additional forms for Blue Cross/Blue Shield and Coventry One are below.

The form for BCBS is here.

The form for Coventry One is here.

If you have a different insurance, please contact them directly for this form.

We encourage you to be proactive with your insurance company so you receive the reimbursement due to you according to your plan.

 

3. How much will I be reimbursed?

The rate of reimbursement will depend on your particular plan, the deductible, and the level of co-insurance or secondary insurance for out-of-network providers. We encourage you to call your insurance company for more information.

Every insurance policy is different and is individualized for you, thus, we do not have access to it, nor can we give you any information about your policy and what it will pay.

It is important for you to ask your insurance company for information about out-of-network benefits for your individual policy and how to file for them.

 

4.  Do you take Medicare?

Our services are considered non-billable to Medicare because we spend more time with our patients than what Medicare allows, therefore, we have opted out of Medicare and you may not submit receipts for reimbursement.

That being said, we have many Medicare patients that use our integrative, holistic services because they desire the high quality of care they receive from us.  This is a decision you must make for yourself. If you have Medicare and you choose to use our services, you will be expected to pay in full at the time of the appointment which is our standard policy.

5.  What if I have Medicare and a secondary commercial insurance – can I submit receipts to my secondary?

If Medicare is your primary insurance and you have a secondary commercial insurance, then we are not able to give you a receipt to submit for reimbursement. This is because we are out of network with Medicare. If you have a commercial insurance company as your primary insurance and Medicare as your secondary insurance, we recommend you call your primary insurance company and inquire on how to file.  We do not have any information about this; it is unique to your policy.

6. Do you take Medicaid?

Dr. Bradt accepts Medicaid ONLY for newborns, infants and children on a limited basis.  Please contact us by phone or email  to see if we have availability and if you meet the criteria for acceptance into the practice. Priority is given to family members of current patients and newborns as well as those children seeking functional, integrative medicine approach for their children and based on our capacity on a month to month basis.

Some of our services  and kit fees for specialty test are not billable to medicaid and considered out of pocket expenses with payment  expected at the time of service.  Please review which services are not covered  with our office staff.

If we are closed to Medicaid that month or you do not meet the criteria we have established for our practice, you are still welcome to become a patient, however you will establish as a self pay patient and  be expected to pay in full at the time of service according to our standard fee schedule and we will not bill medicaid.  It will also be important to ensure that your medicaid card is not assigned to us.

 


7. Are there any insurance companies that reimburse at a higher rate for your services?

Unfortunately, we do not know of any insurance company that will reimburse at a higher rate for out-of-network benefits.  Your rate depends on your individual plan which has been tailored to you.   We encourage you to shop around for the policy that best fits your needs.

8.  Can I bill my labs through insurance?

We work with all labs and can order labs through the lab of your choice. For routine and traditional labs,  Labcorp or Mission labs for children if needed.

All conventional labs  can be billed directly through your insurance by giving the lab your insurance card.   If your insurance does not cover labs, your deductible is too high or you do not have insurance, we can offer you a special discounted rate.  Please inquire about this with our front office. You will  pay Family to Family directly at the time the labs are ordered and then take your requisition to the lab.   These rates are up to 200% less than what you would pay out of pocket to the labs.

Specialty lab testing such as heavy metals, nutritional evaluation, stool analysis, food sensitivities are typically ordered through  Genova or Cyrex .   Pricing on these labs depends on your insurance.  Please see the links to the labs or inquire about this with our front office.

9.  How much do you charge for your services?

Please click here to access our updated fee schedule.

10. Do you take Care Credit?

We are in the process if learning more about CareCredit but do not accept payment for services from Care Credit at this time.  To learn more about what services they cover, click here.