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. Do you take CareCredit?
  10. Do you accept Health Savings Accounts?
  11. How much do you charge for your services?

 

 

1.  Does Family to Family take insurance?

The doctors at Family to Family are committed to providing comprehensive Functional Medicine and  Integrative and holistic medical care for our patients.  In order to do that effectively 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 directly.  You, however, can submit our receipt to your insurance and see if they will reimburse you or if your payment can be applied to your deductible.

In the insurance model of care, a 15 minute visit pays more than a thirty minute visit and an hour visit is often not possible.  Thus, doctors  don’t have tie to listen to patients and have a huge incentive to fit more patients into a day.  No wonder people feel rushed and not thoroughly cared for. We believe you and your doctor choose how much time you need, rather than your insurance company.

We don’t do that.   That’s not our model of care.  If we were to contract with insurance companies, we would not be able to offer the type of care that so many need and are not receiving.

Instead, we take time to listen deeply so we can understand every patient as a human being and address the root cause  with a comprehensive plan tailored to your needs.  If this is what you are looking for then we may be a good fit.


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

At the time of check out, please ask our office staff for an insurance-ready receipt. This receipt will have the appropriate billing and diagnosis codes that you can submit to your insurance company for reimbursement directly from them.  The amount you will receive depends upon your out-of-network benefits and your deductible. Please check your policy or with your company to better understand your plan.

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.

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?

That is between you and your insurance company.

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.  We do not have access to this information 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?

No.  We have opted out of Medicare and you may not submit receipts for reimbursement.

That being said, many people with Medicare work with an in-network provider for their primary needs and  see our physicians for functional integrative medicine and consultations periodically.  They choose to pay out of pocket  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.

Labs however can be billed to Medicare – although some may not be covered.  Please review Lab billing with our office staff at the time of service.

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

Sorry, the answer is still no because of the opt – out rules established by Medicare.

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 opted out with Medicare.

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.  NOTE we are currently at capacity and CLOSED to all new medicaid. 

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. 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.

10. Do you accept Health Savings Accounts?

Yes

11.  How much do you charge for your services?

Please contact our office by email or phone to better understand our unique services, fees and cost of care.

We bill based upon time with our physicians.  Our rate is $348 – 600/hour billed 15 minute increments.   New visits are 60-90 minutes. Follow-up visits are 15 – 60 minutes. This includes the opportunity for  phone and Skype consultations directly with our doctors provided you have established with us for an initial visit face to face.

A non-refundable $150 deposit is required to hold your intake appointment in our physician’s schedules. Payment is accepted by check, cash or credit card.