Payment and Insurance

I collect payment at the time of services. I expect payment in full. I accept cash, check and credit card. I will give you a "superbill" which you may submit to your insurance company for reimbursement for the office visit. Most insurance companies will reimburse you, unless you have an HMO. In addition to office charges, any lab or test charges will be billed by the company involved in doing those tests. Those companies bill your insurance directly, although if you pay them at the time of service you may get a discount.

I am not contracted with any HMOs.

If you have a PPO, your provider would reimburse you more if I were on their list of preferred providers. For example, they would reimburse you at 85% of office charges if I were on their list, but only 50% if I am not. (Numbers used for illustration purposes only). I am a preferred provider with one insurance company, Coventry Health Care (includes the Mail Handlers Benefits Plan and the National Association of Letter Carriers).

I have discovered that the vast majority of health plans do not allow a contracted provider to have patients pay at the time of the visit. Because I do not have staff, I do not have the time or resources to devote to billing and collection of denied payments. If I change my mind and have a sudden influx of time, I will update this space and let you know. I feel that my fees are quite reasonable. Frequently after insurance reimburses they amount to little more than a copay at participating providers, and my services are far superior. Try it; I think you will find that I am worth it.

You should check with your insurance company to find out how their process works. You are responsible for knowing what they cover, what they don't cover and how to submit your charges for reimbursement. Most plans have a form that you will need to submit with the superbill that I will give you. Insurance is very complicated and it is important to be an informed consumer.

This picture illustrates how I feel when dealing with insurance companies.

Central California Alliance for Health

Contrary to all my negative insurance comments, I do occasionally accept patients who have Central California Alliance for Health (Santa Cruz County's Medi-Cal plan).

Medicare

I have chosen to opt out of Medicare. This means that I cannot bill Medicare for anything anytime ever and that you cannot request that Medicare reimburse you for my services. If you have Medicare, I would be happy to be your physician, but you will be responsible for the charges personally. I will need you to sign a contract agreeing to this. In addition, if you have a secondary insurance, they will not pay. The way the system is set up, secondaries will only pay after Medicare has paid their share. Since I am not billing Medicare, secondaries refuse to pay at all as well.

I have chosen to do this for two reasons:

1) For the purposes of Medicare, Santa Cruz is classified as a rural county. This means that physicians in Santa Cruz are paid at a rate that is about 15% lower that physicians in surrounding counties that are not rural (who are already underpaid as well). Anyone who lives here knows how ludicrous this is. Activist have been working on changing this at the state and federal level for several years to no avail. I feel that until additional physicians decide not to accept Medicare, those in charge will continue to take advantage of us. I feel bad about making it difficult for Medicare recipients to see me, but for the time being, I feel it is necessary. Write your congressperson!

2) The Medicare system is incredibly complicated. If physicians do not follow the rules exactly right, they are exposed to audits, fines up to $50,000 per incident, revocation of their licenses, and even incarceration. As a solo physician, with no office staff to assist me, I feel it is too risky for me to take Medicare at this time.

Benefits of paying out of pocket

By not billing insurance I am able to focus my attention on you, rather than on fighting with your insurance company to obtain necessary services. Free from many of the bureaucratic hassles of dealing with insurance companies, I am able to dedicate significantly more time getting to know you as a person. I do not need to hire a billing service, and therefore save costs which allows me to spend more time with each patient.

There are also advantages to you with paying cash, although they are not so immediately apparent. By helping the system to be more transparent (through letting you see the cost of your health care and what your insurance pays for), you are able to make a more educated choice about how your health care dollar is spent.

Paying directly for your health care promotes better health. When we don’t see the cost of care directly, we lose the ability to distinguish necessary care from desired care, and more easily give up our role in our own health.

Insurance has evolved into a very expensive pursuit of the illusion that we are getting something for nothing. The current system is not sustainable. The rising cost of premiums, deductibles, and copays, coupled with increased denials of coverage, means patients are paying more and more out of pocket. This trend is likely to continue. By paying for medical services directly, you are paying for what you value (medical advice and treatment), rather than the layers of bureaucracy that have come to impede excellent care.

Fees

Please note: If you have extenuating circumstances, please speak with me, I am willing to discuss adjusting my fees to meet your needs.

A word about hospital care: I may work out arrangements with the hospital groups in town to care for my patients who are hospitalized at times.