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.
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
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
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
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). I am not able to take children with Medi-Cal however.
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:
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!
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.
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.
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
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
Meet and greet (about 15 minutes, no medical advice given, this visit is for both of us to determine if we are a good fit)
Very simple visit for returning pt (10-15 minutes)
Somewhat more complex visit (approximately 30 minutes)
New pediatric visit
Yearly physical exam
New adult patient visit (functional medicine evaluation)
$200 - $250, depending on travel distance
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 am no longer seeing patients in the hospital. If you need hospitalization, I have an arrangement worked out with the Dominican Hospital Hospitalist staff to take care of my patients.