The Major Medical Insurance industry is based on a “sickness” model of care, and many of our services differ from that model radically. Allowing a failing system with different values to dictate the actions of our clinic, and effectively tie our hands when it comes to providing appropriate and complete patient care is not an option. Simply put, if you want different care, you have to play by different rules.
To that end, our office does not directly submit any insurance claims for Functional Medicine services. We can, however, provide you with the most appropriate codes available, which you can submit to your own insurance carrier for potential reimbursement for your expenses. Note: the codes available are general wellness and nutrition codes, and are not “Functional Medicine” specific. Our office can not guarantee reimbursement of any kind; please contact your insurance carrier for further information on reimbursement. Also, our Doctors and staff are ready to provide service directly to our patients; however, other than providing the appropriately coded invoices, they do not get involved with any other insurance processing.
If you would like our office to provide you with a “coded” invoice, please notify the front desk BEFORE your session begins. Once your daily paperwork is processed, it can not be changed.
About Lab Testing:
Many of the lab companies we work with DO accept insurance (with some exceptions).
We strongly recommend paying out-of-pocket for your lab tests. When a lab company submits a bill to your insurance company, the prices submitted are at Usual and Customary Rates (UCR), which are dramatically higher than the out-of-pocket pricing which they offer directly to patients. Occasionally, the insurance company will opt not to pay for specific testing, and the lab company will, in turn, bill the patient for any outstanding UCR balance; which, in most cases, will be more than the original out-of-pocket price. Paying for the testing right from the start helps to protect you against a very unpleasant “balance-bill” situation,
Whenever possible, we strongly recommend utilizing the lab testing and services offered through our clinic. Often times, our office can get you much better pricing than you might get through conventional medical clinics, or through insurance. It’s also important to use our testing options, as we know exactly which testing is needed; if you opt to get the testing done somewhere else, we can not guarantee accuracy or completeness, and may have to have the tests re-done, which causes unnecessary delays, and costs more money.
What about discount web sites that offer lab testing?
Certain websites such as HealthCheck USA and others offer fairly complete test panels, and a doctor’s order is not required. Please know that as extensive and comprehensive as these test panels appear, even they sometimes don’t tell us the whole story. We highly recommend waiting until after you have met with Dr. Sweeney before ordering any lab work on your own, so you’ll know exactly what tests you need. However, again, there is no guarantee that the testing will be complete or accurate.
Please rest assured, that insurance coverage does not influence Dr. Sweeney’s decision making, standard of care, testing orders, or other recommendations. Whether or not you carry insurance coverage, you will receive the same thorough treatment and high quality of care.