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.