INSURANCE INFORMATION FOR FUNCTIONAL MEDICINE/PRIMARY CARE

We are within the Direct Primary Care (DPC) model but WITHOUT membership fees!!!! This focus allows a more personalized, patient-cetered approach to healthcare; longer appointments, direct access to your provider, better preventative care and superior overall healthcare.  

As a patient of our practice, you will receive Patient-Centered Care without the costly fees! Our doctors spend approximately 45-60 minutes with you during your new patient visit and approximately 30-45 minutes with you during your follow-up visits. 

However, if you have insurance, you are able to submit your own billing to insurance for your office visits AND you are able to use your insurance for labs, imaging, medications, etc. (We just do not accept insurance for office visits only but our fees are very affordable and per-service----so you pay as you go, without contracts and membership fees. 

FUNCTIONAL MEDICINE/PRIMARY CARE VISITS:

We are considered out of network for Functional Medicine & Primary Care OFFICE VISITS. Our providers pride themselves on spending time with our patients during appointments. New patient visits are approximately 45-60 minutes and follow-up visits are approximately 30-45 minutes. Insurance tends to restrict and limit the time spent to an average of 15 minutes; which is exactly what we DO NOT do! We have been able to properly diagnose and treat patients mostly in part by spending time with them. 

Do you have insurance?

What insurance will cover: basically everything BUT the office visit. Insurance will cover lab work, diagnostic imaging, medications, referrals to specialists, if needed. If you would like to  request reimbursement from your insurance for the office visit, please ask us for a Superbill.  As a disclaimer, since each insurance plan is different, we encourage you to inquire about coverage for these services BEFORE you have them completed. There are a lot of factors to consider; such as: deductibles, plan limitations and exclusions and frequencies. We have no way to know this information as this is the responsibility of the patient to know and understand their coverage. 

NOTE ABOUT PRIOR AUTHORIZATIONS:

Please note that as an out of network provider, we do not perform insurance prior authorizations. There are certain compounded medications that might not be covered. Always check with us for self-pay rates if you have a high deductible or uncovered services to help save you money. 

Are you self-pay?

No worries! Our fees are low and affordable. We also have relationships with various labs and diagnostic imaging to provide you with low cost medical services.  We have several cost effective solutions for all patients. 

We also accept HSA/FSA and Care Credit as an approved medical facility and all services are eligible. 

Check out our fees!

We believe in full transparency. Please see Fee Schedule that is published online. 

ACUPUNCTURE VISITS:

We are in network with several insurance companies for acupuncture. Please understand that coverage and benefits for acupuncture are much different from coverage for traditional medical services. For example, not all plans cover acupuncture. Some plans only cover certain conditions and are very strict on that. Most plans only cover a certain amount of visits per year and also limit what can be done at each visit. We do wish that more insurance companies would cover acupuncture and the ones that do, pay for completed services. 

Plans we are in network with for Acupuncture:

We are in network with the following insurance companies. Please note that not all plans within the companies cover acupuncture, so please check to see if acupuncture benefits are available and if we are in network. 

Medicare Part B (red, white & blue card)

United HealthCare 

Payment Policy for Insured Acupuncture Patients:

We require any copayment, coinsurance , unmet deductible or patient responsibility to be paid in full at check-in, prior to your appointment -charged to the card you have on file.  We will then bill your insurance. Your insurance typically is processed within 2-4 weeks. Any unpaid services will be charged to your card on file. 

Insurance is billed for the office visit and acupuncture only.  Insurance typically does not cover other modalities such as cupping, injection therapy, etc. You can add these modalities on for a small fee.  

What Insurance Typically Covers for Acupuncture:

Each plan is different. Please see below for an overview of each plan coverage (keep in mind, these often change):  

Medicare: Medicare only covers a chronic low back for up to 12 medically necessary visits for the first 90 days. Medicare allows up to 8 additional visits after 90 days as long as clinical improvement can be documented to support continued treatments. This is a total of 20 medically necessary visits per year.  Medicare has a provision that states that there can be no evidence of infection, cancer, chronic kidney  or genitourinary pain and other low back pain related to co-morbid conditions.  No other conditions are covered. Office visit and acupuncture (and e-stim) are covered. Limited amount of visits. Subject to copayment, coinsurance, unmet deductible. All other modalities are out of pocket. 

Click HERE to read Medicare's policy. 

United Healthcare: Not all plans cover acupuncture. Acupuncture may be covered by select plans for headache, migraine, musculoskeletal joint and soft tissue pain resulting in a functional deficit, nausea associated with pregnancy, post-surgical nausea and nausea associated with chemotherapy. No other conditions are covered. Office visit and acupuncture (and e-stim) are covered. Limited amount of visits. Subject to copayment, coinsurance, unmet deductible. All other modalities are out of pocket. 

Click HERE to read United Healthcare's policy. 

*Referral may be necessary based on your plan.  Please contact us to confirm insurance eligibility and benefits. 

If you don't have Acupuncture Insurance Benefits:

No worries! Our fees are low and affordable. We have several cost effective solutions for all patients.  Payment is due at the time of check-in prior to your visit with the card on file. 

We also accept FSA/HSA and Care Credit as we are an approved medical facility and all services are eligible. 

Check out our fees!

We believe in full transparency. Please see Fee Schedule that is published online.