As of January 1, 2019, we will no longer be contracted with any insurance companies for office visits (claims will continue to be filed for visits prior to 1/1/19). For the past five years, I have been providing primary care while integrating my training in functional, holistic care. In the New Year, my nurse practitioner, Kristina Plesons, and I want to specialize in functional medicine full time. I have loved that part of medicine more than I ever imagined. I believe there is a greater need for this specialty. This is acknowledged by the amount of patients who have sought care from our office over the last few years. They are yearning for a different type of medicine that truly focuses on well-health and alternative treatments to their health conditions that are routinely ignored by traditional, allopathic physicians.
Because of this change, I will not be able to work within the constraints of the insurance model of pay.
I realize that most already pay for a health insurance plan and expect to be able to use it. It is important to have insurance for unforeseen circumstances i.e hospitalizations, diagnostic testing. My motivation is to help improve healthcare delivery to my patients. Healthcare and insurance is changing. Here we are providing a different style of medicine as compared to the insurance model which focuses on the quick fix solution. Our focus will be on a more long-term individualized plan with attention to prevention and wellness and more time with patients. You will not find this style of medicine in the insurance model.
You can absolutely be seen in this office. Your medical insurance in our office will not be utilized for your office visit charges as it can deter from optimal delivery of healthcare. However, your medical insurance will still be of value and utilized when performing labs or when diagnostic tests ordered. We will provide you with an itemized receipt for your office visit that you may submit on your own to your insurance company if you wish to seek reimbursement for out of network coverage. We cannot guarantee how your insurance company will process this. Some insurance companies will allow use of your HSA.
You can remain or can become a new patient in this practice. We offer a model focused on more time spent with patients to help with their personal wellness. We have also partnered with a local laboratory to offer discounted rates for lab work for our patients.
I have opted out of Medicare for over 5 years now. As for my current patients and for any new Medicare patients, we will continue to operate as a self-pay model. Payment is due at time of service. If labs or diagnostic imaging is needed, these will be billed through your Medicare insurance. If you are on a Medicare Advantage program, they may refuse to pay for services not ordered by one of their providers. I recommend you establish with one of their approved providers so they can order certain tests and provide referrals for you if necessary.
No, we are out of network providers with all insurance plans. My office will provide you with an itemized receipt that you can turn into your insurance if you choose. We, however, cannot guarantee how they will process the claim and whether they will pay. Most insurance companies may allow use of your HSA.
I will continue to provide high quality care that focuses on prevention and education/treatment of chronic health conditions. This will be accomplished more easily as we will extend our office visits since we will no longer be constrained to the 15-minute model. This extra time will allow for deeper investigation into causes of health-related concerns and patient education. I will continue to offer IV therapies with Ozone and nutrient replenishment and Prolozone Therapy for musculoskeletal injuries. I will also be adding more treatment options with the use of PRP/Stem Cells for musculoskeletal injuries, cosmetic concerns as well as treatment for sexual dysfunction.
Most of my patients have chosen me as their physician because of my ability and knowledge to be proactive, utilize many different modalities compared to a traditional Internist (i.e. use of Nature Thyroid. T3 medications, bioidentical hormones, etc.), focus on diet and nutrition and perform in-depth cardiovascular and metabolic screening to achieve total wellness. I have encountered too many patients over my career that have been ignored by previous doctors for extra testing or use of different medications for alternative treatment. Unfortunately, many doctors find little value in treating the whole patient. They tend to focus on treating an isolated symptom without looking at the entire history and environmental factors that contribute to illness. I will continually learn and stay up to date on new advances in functional medicine.
Yes, we prefer to perform a Wellness/Preventative exam once a year for our patients. This will include a thorough review of your medical health from the past year. An EKG, as well as in-depth laboratory screening, will be reviewed at that visit. These visits will not be billed to your insurance.
Most patients are being treated for conditions requiring monitoring, so follow-ups will occur between 3-6 months depending on the nature of conditions and response to treatments. These will be determined by the provider at your visit. We will be unable to give medical advice or prescription refills past 6 months from your last office visit.
Yes, I am still available to treat most of your medical problems as I have in the past. These visits, however, will no longer be able to be billed to your insurance.
If you have medical insurance, it will be no different. You may continue to utilize any laboratory of your choice and the tests will be covered at whatever your insurance deems appropriate. If you don’t have medical insurance, I have formed relationships with local laboratories and I have a direct pricing agreement with them to keep costs low.
All patients will be required to do labs approximately 2 weeks prior to your appointment. This streamlines the office process for patients as you can review your labs and concerns with your provider at your already scheduled visit. If labs are not done prior to the visit, you will be notified of your results. If your provider sees concern with your results, you may need to be seen for an office visit to be reviewed.
If you keep your regularly scheduled follow up appointments as determined by one of our providers, we can still prescribe your maintenance medications for you.
If you are seeking to switch to a physician that will be in network with your insurance, I recommend that you contact your insurance company for a list of physicians who may be conveniently located. Another option is to contact the physician referral service - St. Luke’s Physician Referral Service – (314) 205-6060.