We are a concierge medical practice and are considered an out-of-network provider for all commercial insurance. Our patients join our practice at one of three tiers (Member, Priority or VIP) and pay us for services directly. For those with PPO insurance, we can arrange for a third-party company to help you submit claims for medical visits “out of network,” or give you an itemized receipt to submit yourself. Reimbursement would then happen directly to you according to the terms of your insurance policy.
Importantly, most lab tests, imaging, specialist consultation and hospital services that we order can be at in-network vendors for those with PPO insurance. So it’s just our visits and other time spent by our doctors on your behalf that are out of network. We know how much the “real price” is for medications and tests, and can help you get the best value from your insurance and limit out of pocket costs.
Patients with PPO insurance can recover a percentage of the amount allowed (by the insurance company) for each medical visit, after deductibles and coinsurance. Patients with Kaiser or HMO insurance will typically not get reimbursement for out of network services. We are completely opted out of the Medicare system so our fees are not covered by Medicare, although many things we order (medications, specialists, and so forth) are often covered by Medicare. International travelers insurance for Europeans often reimburses patients quite well.
While this can seem daunting, our patients find the value of our services to be so great, and our practice to be so responsive and responsible, that it’s worth going out of network to assure the best possible health care and outcomes for themselves and their loved ones.