Although we previously were “In-network” with most major PPO insurances, we have had to recently go “out of network” with them and we will only be “In-Network” with Blue Shield until May 2018. This decision was made in order to retain control over the way we practice medicine and to be able to spend the time we felt was required to delivery the kind of care we could feel good about. Insurance companies value seeing more and more patients, which results in rushed visits and dissatisfied patients and demoralized physicians. Additionally, since we practice an integrative, hybrid model of care that does not always fit “in the box” with what insurers deem as necessary (vaccines, blood tests, etc), we would have to compromise how we practice medicine in order to keep this 3rd party happy. In short, we realized that staying in network with insurance would result in us not being able to practice medicine the way our patients would have us do. Rather than compromise our practice, we opted to get out of the system instead.
Therefore, patients can be seen with payment for services due at the time of service. If you have a PPO plan, we will provide you with an itemized super-bill (including the necessary procedural codes) and receipt that you can then submit for reimbursement with your insurance plan. Depending on the plan you have chosen, the reimbursement will vary per the conditions of the plan. Patients that have Kaiser, HMO and Medi-Cal plans will typically not be reimbursed for their visit. We encourage all patients to look at the terms of their coverage prior to their visit. For those patients that want to be seen but find that they do not want to pay for an expensive PPO yet they get poor reimbursement for their visits, we would encourage you during open enrollment to reconsider the types of insurance coverage purchased or selected. Many patients who see many practitioners who are out of network with their insurance will opt for a lower-monthly expense insurance plan to offset the out of pocket costs and find it may be more affordable in the long run. They will do this either by selecting a lower cost, higher premium PPO, medical-cost sharing program (used primarily as catastrophic insurance) or a Health-Savings account.
WHAT ABOUT LAB TESTS, X-RAYS AND SPECIALISTS?
While we will be out of network with your insurance, this does not mean that all the labs or X-rays that we order will not be covered with your insurance. We will take a copy of your insurance information and will submit this information along with the lab specimen in order to have the tests covered with your insurance plans. Some of the specialty labs tests may not be covered completely with your insurance, but this is unchanged as to whether or not we are in network with your plan. These can be discussed on an individual basis during your visit.