Let’s start with a little visualization before we answer that question: You check-in at your doctor’s office.  “What’s your date of birth?”, they’ll ask.  (Yes, you are a medical record number and a date of birth).  You’ll then sit down and wait…and wait…and wait (I know you checked your watch, cell phone, or the wall clock a few times). 

Someone calls you back and you get excited.  Maybe you make a stop at the “vitals station” so that they can take your blood pressure, pulse, temperature, and weight, before bringing you to a room.  One of two things happens at this point.  Option 1:  Said MA takes a brief history and then steps out, or Option 2:  As soon as you are in the room you get a “the doctor will be right in” or similar version.  After which, you start the “wait game” all over again in your new setting.  

Finally someone will pop in (I know you’re excited again).  The question at this point is who will it be?  It may be the MA again, a medical student, nurse, or PA.  If it’s your first visit to that clinic, it may even be the actual doctor (don’t be surprised if you don’t see that doctor again at a follow-up).  “What brings you in?” they ask.  And from there, it quickly becomes evident that the 15 pages of required intake you filled out ahead of your visit were not actually read by the provider.  With this, you probably begin to rattle off your concerns as quickly as possible, trying to make sure you get everything in during your appointment.  This is where they may stop you to explain that they can only treat 1-3 things at each visit, due to insurance constraints (It seems untrue, but it’s actually true).  And then you’re done- paper in hand.  You’ve probably been given a lab order, imaging order, or prescription (or all 3!).  And off you go to figure out on your own what your next steps are supposed to be.

What the heck just happened?  I know you want to be angry at the office, but it’s not them (usually), it’s your insurance company.  The insurance companies are the ones who are really pulling the strings and making the rules.  And the office is checking off the boxes that will be required of them when they bill.  The whole office is probably so overwhelmed that they are going to do as much as possible to avoid making more work for themselves.  Unfortunately, this means that the labs or imaging you actually need may not get ordered.  You may get a prescription that they know won’t work, because you have to fail that prescription before you get the one that you need, and they can’t offer you counseling on something they know you need, because insurance doesn’t reimburse for the code they need to bill for that counseling.  meanwhile, you- the patient- is the one that suffers. 

So the short answer is, our office visits are not in-network.  We do this so that you get the best possible care that we can provide, and that we believe you deserve.  You have one doctor, that you will see every time, for the whole visit.  You have the office Ninja, Heather, that will be your personal go-to and will always get back to you.  To circumvent healthcare costs, we bill as much as we can through insurance (labs, imaging, medications, referrals). For our patients with high deductible plans, we find the absolute most competitive cash pay pricing to save them money.  Honestly, we make a lot more work for ourselves, so that you don’t have to be left in the cold, trying to figure it all out. We are also happy to provide the appropriate paperwork for your insurance company, to submit for out-of-network reimbursement.  Your medical expenses are a tax write-off, so we will send you a receipt after every visit.  Have more questions?  Give us a call.  Heather is amazing at insurance!