Why do we do things this way?
Keeping our billing simple and straightforward allows us to spend more time with you, rather than your insurance company. Instead of rushing through visits in 5 or 10 minutes, we can spend the time we need to get to the bottom of your medical problems.
Working with insurance adds a lot of complexity to the business side of medicine. In order to be reimbursed, most doctors have to hire billing and coding specialists to help them communicate with the insurance companies. All of this extra work is expensive – in order to pay for all the extra staff, most doctors try to squeeze as many patients as they can into each day. (This is why so many people wait for an hour or more, only to see the doctor for a rushed 5-10 minute visit.) By contracting directly with you, and not with your insurance company, Braeswood Endo can offer concierge-level service at a price that is within your means.
Wait, so I can email my doctor?
Yes! Insurance companies generally reimburse doctors only for time spent face-to-face with patients, and don’t pay doctors for their time spent communicating with patients by phone or email. This is the reason that most doctors require a face-to-face visit (and a copay!) any time you have a question, even if the question could have been answered with a quick phone call or email. We understand that your time is valuable, and if we can take care of you appropriately without an office visit, we will.
Is this concierge medicine?
Concierge medicine usually refers to a practice that charges their patients a hefty "retainer" fee and then bills their insurance for each visit. What this means for the patient is that you are charged twice - once by the practice, and again with every co-pay charged by your insurance company. Concierge medicine is generally considered to be a high-end, luxury product. Braeswood Endocrinology provides concierge-level service at a reasonable price, without the hassles of insurance.
Can I still use my insurance to pay for labs, imaging, or medications ordered by Dr. Zwiener?
Of course - although our lab prices may still be cheaper than using your insurance. And if you do not have insurance, we can help you find the lowest prices on any labs, imaging tests, or medications that you need.
What are out of network benefits?
Many of our patients with health insurance have a portion of their visit fees reimbursed using their out-of-network benefits. After your visit, Dr. Zwiener can provide an itemized receipt (“superbill”) with all the necessary information for the insurance company to provide your reimbursement. Before your visit, we recommend that you call your insurance company to confirm your deductible and out-of-network benefits. We find that most of our patients are reimbursed for around 50-60% of the visit cost. You may use HSA/FSA funds to pay your visit charges, leading to further savings. Out-of-network benefits can NOT be used to pay monthly membership fees.
Using out-of-network benefits allows us to maintain your confidentiality. When in-network benefits are used, the insurance company requires us to divulge your personal medical information, and they use this information to decide whether or not to cover your visit, labs, and medications. When out-of-network benefits are used, only diagnosis codes are required, and your personal information remains confidential.
Depending on the details of your plan, using out-of-network benefits may not be much more expensive than using in-network benefits. When you use your in-network benefits at a traditional endocrinology practice, you are generally charged a copay, which for specialist visits is often $50-$100. After the visit, you may receive another bill for any remaining charges not covered by insurance.
Practices who are in-network with insurance companies contract with each insurance company to receive a discounted rate. In order to stay profitable, these practices must set their base rates high, so that the discounted rate paid by the insurance company is not too low. Insurance company contracts require that all patients be charged the same rates - which means that self-pay patients are charged the most! Braeswood Endocrinology charges reasonable rates, not inflated rates. If you have a high deductible plan or you are not insured, you can be assured that our rates are significantly lower than what you would be charged at a traditional practice.
Can I use my HSA or FSA?
You can definitely use your HSA or FSA to pay for imaging studies, blood tests, and pay-as-you-go visit costs. It’s a little less clear whether you are permitted to use your HSA/FSA to pay for membership fees. The IRS has complicated rules, several of which conflict with each other. We recommend that you consult your attorney or accountant to discuss this issue. For an in-depth discussion of the specific statutes involved, click here.
What happens if I'm in the hospital?
Give us a call! Dr. Zwiener isn't able to see patients in the hospital, but she is more than happy to speak with your care team, and she will help you safely make the transition from hospital to home.