An Explanation of Our Financial Policy
On follow up visits, again the insurance pays for the usual and typical services that are performed during the first 12–15 minutes of your visit. The above and beyond services that are provided during the rest of the visit time are covered by the membership fee.
Advanced lab testing interpretation can at times take 45 minutes to one hour and at times it requires special consultations with other providers or with the laboratory company. These above and beyond services are covered by the membership fee as well.
All of the additional above and beyond services are reviewed on the intake agreement. If you have further questions about this, feel free to contact us about them.
The Insurance Dilemma
1. Health insurance companies and Medicare only allow for a limited amount of allowed or covered procedures and medical care.
In general insurance companies are not focused on wellness or preventative health care. Neither are they focused on keeping up with the most recent and applicable scientific advances. There may be a limited set of covered services but they are restrictive and do not take into account the most up-to-date clinical research and evidence. In general, it takes 15–20 years for clinical research to become the ‘standard of care’ and for some advances it can take longer (handwashing in the mid 1800’s took decades until it was fully accepted throughout Europe). Providing the most up-to-date and relevant care is what Integrative and Functional Medicine is all about. The insurance industry is heavily invested in the conventional model of health care that too often relies on drugs and surgery. We are committed to the functional medicine model that addresses the underlying causes of your symptoms with specific nutritional and lifestyle recommendations and applies the most recent advances in scientific discovery and care delivery.
2. Insurance company’s reimbursements only cover accepted diagnoses as determined by the ICD-10 coding and diagnosing system.
Any illness outside of this system or any time required that is over and above the allowed time is not reimbursable. In general, these established fees cover the actual cost of the briefest (and we believe the lowest quality) care. At the same time, the participating provider’s office overhead costs have increased dramatically because of the staff, time, and equipment necessary for processing and tracking claims. In today’s healthcare environment, the actual cost for doctors to provide services continues to rise, while the percentage of reasonable fees that insurance payments cover is declining. Most doctors and clinics cope with the requirements of being participating providers by keeping their office visits brief so that they can see many patients within a given timeframe. When their clinic becomes unprofitable, it must be supported by another institution. Many primary care medical clinics are not self-sustaining financially and have had to merge with hospitals whose expensive, high-tech surgical and diagnostic procedures are priced to keep the clinics afloat financially.
3. Finally, Integrative Medicine and Functional Medicine are not presently recognized by the insurance industry.
Integrative Medicine is a board specialty recognized by the American Board of Physician Specialties and Functional Medicine is currently being practiced at over twelve university hospitals and there are multiple integrative residency programs. Some of these include the Cleveland Clinic Center for Functional Medicine, The George Washington Center for Integrative Medicine and The Arizona Center for Integrative Medicine. Despite these facts, many services provided under these specialties are not reimbursable.
Membership Provides a Way Forward
A membership fee allows us to be able to provide the most advanced, comprehensive and personalized care and not have either our scope of practice or the time allowed with patients to be reduced or constrained.
$3249 for the Initial Term, which includes:
- A non-refundable initial membership induction fee of $1170. The initial $585 shall be paid upon execution of this Agreement and the remaining $585 of the induction fee shall be due and payable at Member’s initial consultation
- A fee of $189 per month for the remainder of the Term. The first monthly fee shall be paid after Member’s initial consultation and then no later than the 10th of the month for the remainder of the Term.
Cash / Non-Insured Individuals
$3200 for the Initial Term, with the intake exam fee of $1100. The initial $550 shall be pain upon
execution of this Agreement and the remaining $550 will be due at time of the consultation; and a fee of $175 per month for the remainder of the Term. The first monthly fee shall be paid after Member’s initial consultation and then no later than the 10th of the month for the remainder of the Term.
Understanding Our Rates
Our rates for membership were determined in order to maintain the same revenue stream as our usual office visits. In our intake, the patient will be in the office for two hours (equivalent to 8 typical office visits) but the insurance will only reimburse for the first 15–20 minutes of the time, equivalent to one office visit. The time needed to review the complexities of a patient’s case and integrate new medical information is also not covered. Advanced Functional Testing is complicated and in some cases requires us to consult other specialists to help interpret it and this is not covered either. Instead of charging for all these individual services we rolled all of them into our membership program.
As well a clinic like ours requires highly trained staff and extensive, expensive professional continuing education. The majority of our fees support the overall mission of providing high-quality health care.
Nutrition & Functional Medicine
We may recommend nutritional supplements as an adjunct to dietary and lifestyle modification. This approach is central to the well-researched and science-based practice of functional medicine, which all of our professional staff have studied. We recommend therapeutic, quality nutritional supplements as a service to our patients. With a few exceptions, we do not recommend nutritional products of similar quality to those that are widely available over the counter. We recommend high-quality nutritional products from the top nutritional research laboratories in North America and Great Britain.
To maintain financial transparency, we do not sell supplements in the office. We have set up an online formulary using Fullscript. This service is offered at a 20% discount relative to the retail pricing. The fees charged for this service are for the maintenance of the site as well as the research and work entailed in maintaining an up to date formulary. This allow us to offer the highest quality supplements but at a significant discount to patients. Lower end products many times can be purchased at a cheaper price on Amazon but may not be as effective and often sit in storage warehouses for extended periods of time. To learn more about supplement quality and potency click here.
For more information on our nutritional supplements (including financial policies), please visit our supplements page.
What Does Your Membership Cover?
Functional Medicine is an evidence based systems biology approach to human health, functioning and disease. Integrative Medicine seeks to unite different medical & therapeutic modalities into a coherent treatment plan. This is a time-intensive process that requires advanced testing and evaluations not presently covered by insurance plans.
At RIFM we provide all your standard care through insurance. All ‘above & beyond’ care is then covered through your membership agreement.