Our Direct Care Model - What is a Direct Pay Clinic?

Dr. Veerula is transitioning to a Direct Pay Practice, effective January 1st, 2019.

No insurances are accepted; all services must be paid in full before or immediately after they are provided. Prices for all services are 100% transparent. No insurance is accepted, and certain patients who have government insurance policies (Medicare, Medicare Advantage or Medicaid) are not permitted to be seen for non-cosmetic services due to government regulations. (For some of the government insurance policies, Dr. Veerula may be able to see select patients at Fort Wayne Integrative Medicine’s location at 7802 W.Jefferson Blvd on Friday’s.)

Please take time to carefully review the information below to see how this will impact your care.

What is direct pay and why is Dr. Veerula choosing to transition to a direct care model?

This is a non-traditional practice model that Dr. Veerula is passionate about and feels foster stronger doctor-patient relationships.

At Integrative Dermatology, Dr. Veerula takes the bureaucracy out of the practice of medicine, consequently improving medical care, by opting out of Medicare and discontinuing contracts with private insurance companies.

A direct care model is simple, efficient and cost-effective. It saves you time and money in the long run. It’s the same as going to get a hair cut. You schedule an appointment, arrive for your service, and then pay for it. Direct physician care practices operate much the same way. No hidden fees, no surprise bills, no co-pays or insurance cards. Just straightforward medical care when you need it. This is different from a concierge model, as there is NO membership fee.

Direct care models are free-market based. It gives the power and freedom of choice back you, the consumer. In a free market, no one forces people to buy a product nor does it tell consumers where to buy it or how they must use it. Why should it be different with healthcare? In the traditional medical model, your insurance dictates the type of care you receive, WHO you can see for your care, and which medications you receive. This is NOT the case in a direct care model…

What are the benefits of a Direct Care Model?

Direct care models decrease costs by cutting out the overhead that comes with insurance companies and regulations. The cost of your complete office visit is no more than the average cell phone bill, and you are empowered by knowing what these costs are BEFORE services are rendered.

Dr. Veerula DOES believe that medical insurance is beneficial, but it should be reserved for large, expensive and catastrophic events, like car, disability or life insurance — not your routine daily care. Take car insurance for example. Imagine how expensive and unaffordable your car insurance would be if you used it to pay for gas, oil changes or new tires. It would result in exuberant car insurance costs, lack of price transparency, over-utilization of services and subsequent insurance control of the care of your vehicle. This is exactly what has happened in medicine.

At Integrative Dermatology, Dr. Veerula aims to restore the traditional practice of medicine when medical decisions were made between the doctor and the patient — and not dictated or influenced by third parties. This type of practice model will allow Dr. Veerula to spend more quality time face-to-face with you and less time waiting for your appointment. Your time is valuable and Dr. Veerula appreciates and acknowledges that.

How does a direct care model work?

For patients with private insurance (non-Medicaid, non-Medicare) this means that you would pay Integrative Dermatology directly for your care. Please see “Pricing” for more details on our transparent fees. Health spending and flex spending accounts are accepted forms of payment for medical services. For those with private insurance, upon request, we may provide you with an itemized and coded form to submit to your insurance company for reimbursement. Not all insurance companies allow reimbursement for services. It is the responsibility of the patient to check with their insurance providers regarding rules regulating reimbursement.

All patients will need to sign a “Private Contract” before being seen for any medical services at Integrative Dermatology. For those patients with Medicaid or Medicare, you cannot be reimbursed by Medicaid, Medicare or any supplemental insurance for any services rendered by Dr. Veerula. This however, does NOT change any of your Medicaid or Medicare benefits in any way and your insurance will remain in full effect for lab, x-ray, hospitalization, and all services provided by doctors who do participate with your insurance. This only means that Medicaid or Medicare should not be charged in any way for the services rendered by Dr. Veerula.

Because pathology is not performed in-house at Integrative Dermatology, patients may elect to use their insurance (with the exception of Medicare HMOs) to pay for any necessary labs or pathology ordered by Dr. Veerula.

COMMON QUESTIONS

If I have insurance shouldn’t I use it?

We all own various types of insurance – car, home, health. Let’s look at car insurance. Most of us purchase comprehensive or collision car insurance policy for a reasonable fee, in case of emergencies (i.e. severe damage). Now the insurance company is liable if there is severe damage. This is how insurance is supposed to work: insure you against things that would be financially devastating.

Does your car insurance cover oil changes or new tire for your car? Of course not. Those costs are maintenance. If your insurance covered those costs it would quickly become very expensive. What if your neighbor drives 35,000 miles a year while you drive 5,000? Should you really pay the same for maintenance? Unfortunately, in this country we have started wrapping “oil changes and new tires” into the cost of medical insurance. As a result, the costs of medical “insurance” have skyrocketed, impacting the consumer and practices alike.

Direct-pay practices seek to separate “maintenance” – like a yearly checkup, visit for warts on your foot, or sinus infection – from catastrophic medical events like a heart attack, cancer or trauma. The latter are rare events so they’re perfect for insurance to cover.

Many Americans stand to do better by separating “maintenance” from catastrophic coverage. By combining a high-deductible health plan with smart expenditures of your health care dollars for “maintenance” most folks can get better care for less money.

Are all patients accepted?

All patients are accepted with one exception. Government restrictions bar us from seeing patients with any type of government insurance including Tricare, Medicare (including Medicare Advantage plans) and Medicaid (including PMAP) insurance unless the visit is for cosmetic purposes only. We realize that this is frustrating, but we have to follow the rules. All patients will be required to sign an affidavit in-person, before their visit, attesting to the fact that they do not have any type of government supported insurance or are being seen for a statutorily non-covered service (i.e. cosmetic surgery).

If you have any type of private insurance, or no insurance, you may be seen for any concern (medical/surgical/cosmetic) at any time and without restriction. Upon request, we will provide a medically-coded “superbill” that you may turn into your insurance company. They may, at their discretion, credit the amount that you paid towards your deductible or reimburse you for your expenses. However, this is not guaranteed and determine on a case-by-case basis. We do not communicate at all with any insurance company including prior authorizations for medications. Exceptions may be made, at the discretion of the practice, on a case-by-case basis.

What’s a deductible?

A deductible is the amount of money that you must pay out-of-pocket before your insurance is required to “kick-in” and pay. For example, if you have a $2,000 deductible you are a “cash payer” until you reach $2,000 in medical expenses within a year. If you break your leg and need $3,000 in care, then you would pay the first $2,000 and your insurance would pay the remaining $1,000.

As healthcare has gotten more expensive, more Americans are seeing increases in their deductibles. In some cases, deductibles can be $6,500 per individual and $13,000 per family.