This is also known as Cash based, but I also take all forms of payment
What does cash based mean?
Insurance Plans are complicated.
Most large institutions have a contractural agreement with the various insurance plans. That is what is called “In Network”.
Some insurance plans will allow you to go “Out of Network”.
Every plan is different, so you must check with your individual plan to determine what might be covered.
A cash based provider means simply that I am not able to process insurance. Many forms of payment will be taken (not just cash), but full payment is due prior to delivery of services.
Please see my page on Transparency in Billing for an explanation on what my fees are and what they cover.
Why must I do it this way?
I am too small to coordinate billing with the vast amount of Insurance plans. Huge, corporate medical offices and hospitals have entire departments devoted just to billing and collections. I want to spend my time taking care of you.
I am too small to wait for payments from the patient. Because corporate medical offices and hospitals have a very large volume of patients, the current cash flow in these centers may be based on services provided months previously. In addition, their model is to see 4-10 patients per hour. I want to be able to see fewer patients, so I can devote more time to each patient. My visits with you will be at least an hour or more. Plus, I spend even more time before the visit in preparation and after the visit in follow-up activities.
Potential Patients often ask me: Do you take My Insurance Plan? This question really translates to: Are you willing to accept the fee that the Insurance company thinks your service is worth?
Here’s an Analogy:
I came into medicine at a time when insurance did not pay for basic office visits. It was my impression that when insurance companies got involved, the costs would go up and they would also start to control who you could and could not see as a provider. That was back in the 80’s. I hate to say “I told you so…”
Think of other things you pay cash for: Groceries, Car repairs, Veterinarian bills, Lawyer fees, etc. You would never think of having insurance to pay for these services. Well, I guess they do have Pet Insurance.
You might say: “But I pay for my insurance, I think it should pay for my medical costs.” While this is true, I feel that our society is starting to recognize that our current insurance model is perhaps not in the best interest of the patient or the provider. More and more providers are going back to a Cash Based model.
Think of this: in today’s world of high priced insurance, long waits to get in to see your provider, and the increase in chronic diseases, consider looking at medical care as a valuable service that has a cost. When you pay cash, you can choose who you can see. And the provider is not controlled by the Insurance company. Here is a website with a good explanation of this process.
Can you still use your insurance?
Perhaps, it depends on your plan. Some companies will make a statement about coverage of functional medicine. Although I use functional medicine concepts, I am a fully licensed medical professional and it is within my licensure to bill for appropriate services. I will give you a “Superbill” that you can submit to your insurance company or Flex Plan for reimbursement. This will include all of the necessary codes your insurance needs to process a payment back to you. The type of plan you have will determine how much reimbursement you receive. Please let me know if your insurance company is requiring any additional documents.
You can check with your insurance plan ahead of time for covered and allowed services.
New Visit CPT code: 99205
Return Visit CPT code: 99215
Preventative Counseling CPT Code: 99404
How does a SuperBill work?
All providers have a list of services they provide with ICD-10 codes (associated with diagnoses) and CPT codes (associated with services). The insurance companies use this itemized form to determine if your diagnosis warrants the type of services you received.
Since I don’t contract with Insurance companies I am at best “out of network”. Your insurance may reimburse you at the rate set forth in your plan: often it is 60/40 (you pay 40% and your insurance pays 60%)
If you have a flex plan, you can submit the rest to that.
For example:
I bill for $300.
Your Insurance pays 60% or $180. Your Out of Pocket (OOP) is the remainder which is $120. You may submit this remainder to your Flex plan. Since Flex is taken out of your paycheck pre-tax, getting back $120 is really like getting an Extra 30% or $40. So that means if your insurance covers it, your fee for an initial office visit would be equivalent to $80 out of pocket. Follow-up visits would be equivalent to $40.
If nothing else, if your insurance approves it, you will be that much closer to meeting your deductibles and co-payments.
Please note, since all plans are different, I have no guarantee that your insurance will cover it or how much.
Medicare plans have a completely different process. I am researching this and will update this page when I find out.
The Center for Happy-NESSS 