AN EXPLANATION OF MY FINANCIAL POLICY
As a physician who practices Functional Medicine, I am passionate about what I do. I feel that I have a calling to provide as many people as possible with the highest quality natural health care. Just as my services are unique, my financial policies set my practice apart from mainstream medicine. I have prepared this page to answer questions you or your family members may have about the rationale for my financial policies. If after reading this you still have questions, please feel free to contact my office.
Why I Do Not Accept Medical Insurance
Many new and prospective patients have asked why I do not bill insurance directly when other medical providers do. I fully understand the financial challenge this presents to some patients, and I wish there were a way for me to bill patients’ insurance companies. Unfortunately, at this time, there is not. In the following paragraphs I explain why.
At the core of this choice is my strong belief that decisions about my patient's medical care should remain between my patients and I, uninterrupted by third party interests (i.e., those of any insurance company).
When medical practices bill health insurance companies directly, the doctors are required to become participating providers. The doctors must sign a contract that allows the insurance company to determine which services they will and will not provide and how much they can charge for those services. In general, insurance companies are not focused on preventive or wellness services. They are heavily invested in the conventional model of health care that too often relies on drugs, procedures and surgeries. As a physician who practices functional medicine, I am firmly committed to prevention, wellness and natural solutions to health problems. My goal is to address the underlying causes of your symptoms with specific nutritional and lifestyle recommendations — interventions that are generally not reimbursed by insurance companies.
A participating medical practice must agree to accept the fees the insurance company establishes, regardless of whether the fees are reasonable or applicable to that practice. In general, these established fees cover the actual cost of the briefest (and I believe the lowest quality) care. Doctors who are participating providers are required to accept discounted fees for their services, and they cannot bill the patient for the difference between their fee and what the insurance company will pay. Therefore, the practice must write off the difference, often as much as 50% or more of the doctor’s fee for service.
At the same time, the participating provider’s office overhead costs have to increase dramatically because of the staff, time, and equipment necessary for processing and tracking insurance claims. Most doctors and clinics cope with the requirements of being participating providers by keeping their office visits very brief, so that they can see many patients within a given time frame.
Ironically, some of my patients complain about their extremely brief and unsatisfactory office visits at other medical practices, while at the same time expressing frustration that I do not accept insurance. Unfortunately, I have found that I cannot be a participating provider in the insurance networks and provide the time-intensive and well researched care that I do.
About the charges for my services
Unlike doctors who are employed in large clinics and hospitals whose salaries are partially subsidized by expensive diagnostic and surgical procedures and hospital fees, I am a solo medical practitioner and I do not collect a salary. My pay is based only on the time and services I provide to my patients.
Like all non-salaried professionals, including lawyers and accountants, I must charge for my time so I can afford to provide excellent care and remain in business. I charge exclusively for face-to-face time with my patients and I do not make any profits off of laboratory testing or supplements. I also spend considerable time each week reviewing my patients’ records and tests and researching their cases in order to provide the best possible care and optimal solutions for their health problems.
At follow-up visits, I spend significant time discussing results with my patients. For example, it is relatively simple to inform a patient that her diabetes blood testing is currently normal; but it is entirely different to discuss the results of more complex functional evaluations and to recommend practical lifestyle and dietary strategies that may help to prevent diabetes in the future. Patients often complain that conventional doctors do little to nothing in the way of truly preventive medicine. In contrast, a primary focus of my practice is to prevent the development or exacerbation of future health problems in my patients and is a key difference that sets my practice apart.
I have chosen this work because it is my passion and calling—certainly not because it is a way to make a lucrative income. In fact, most medical doctors who choose to practice functional medicine know that their income will be substantially lower than it would be if they were practicing in a more conventional manner that is fully supported by the healthcare reimbursement system.
I hope after reading this you have a better understanding of my financial policy. If you still have questions, please call my office at 415-745-3305.