An Explanation of Our Financial Policy
As doctors and staff, we are passionate about what we do, and we feel that we have a calling to provide as many people as possible with the highest quality and most up to date health care possible. Just as our services are unique to this region, our financial policies set us apart from mainstream medicine. We understand, therefore, that you may have questions. We have prepared this page to answer questions you or your family members may have about the rationale for our financial policies. If, after reading this, you still have questions, please feel free to contact us. We’re here to help you toward optimal health.
Do You Accept Health Insurance?
Yes. We do accept all major health insurances. However the services for Functional and Integrative Medicine go above and beyond the typical care that insurance reimburses us for. We bill your insurance for the usually allowable charges, which usually includes the first 20–30 minutes of your office visit. The remainder of the initial two hour intake is covered by the membership fee. This also allows us to use your insurance to pay for the advanced testing that we perform as well as the extensive time to perform your evaluation and testing.
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.
Why Do We Charge a Membership Fee?
The Insurance Dilemma
Many people who have contacted our office for our services have asked us why we charge a membership fee. We fully understand the financial challenge this presents to some patients, and we wish there were a way for us to bill your insurance company for all services provided during your Integrative and Functional Medicine evaluation. Unfortunately, at this time, there is not. Here is why:
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.
Our Fee Structure
Initial membership induction fee of $775 then monthly maintenance fee of $142 per month during the next 12 months of membership
Executive Optimal Wellness
This program is designed for high functioning individuals who want to maximize their performance and health utilizing the most up-to-date testing and procedures to maximize their personal preventative health care. The fee for this is $1500 which includes the initial intake evaluation as well as the 6-week testing review and health plan.
How Do You Determine The Membership Fee?
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 to three hours (equivalent to 8–12 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.
Do You Sell Nutritional Supplements?
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.
In an attempt to maintain financial transparency, we do not sell supplements in the office. We have set up an on line formulary using Full Scripts. This service is offered at a 30% discount relative to the retail pricing. The fees charged for this service are for the maintenance of the site only. We don’t make money on the sales of the supplements. This way we can offer the highest quality supplements without a conflict of interest. The higher end products are offered at a substantial discount, however the lower end products many times can be purchased at a cheaper price on Amazon. This site was set up solely for the purpose of offering the high end pharmaceutical grade supplements at a discounted rate.
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.