Manuevering the Healthcare System

If you are a parent you already know that the healthcare system in the US is difficult to manage. Everybody who has insurance has a different policy and different benefits. You were probably given some choices when you signed up for benefits if you receive them through your job. This means what you pay up front (from your pay check) can vary. It means your co-pays vary. It means what your insurance will and will not pay for varies. Everyone has different deductibles - or how much you have to pay before your benefits kick in. And on top of that there is an out of pocket maximum. OHHHH, and don't forget there are IN network benefits for doctors that are contracted with your insurance and OUT of network benefits (doctors that are not contracted). Your policy may cover lots of types of services - like emergent care, routine check ups, mental health, surgeries and inpatient stays and therapies (OT, PT, and Speech). It may not cover some of these.

Let's say you do have insurance and you use it. Every time you have services you should receive an explanation of benefits (EOB) that will explain what has been charged, how much your insurance covered and how much you owe. I don't ever pay any medical bill until I receive the EOB - and the 2 should match exactly. IF they don't the EOB will help figure out why. Often times claims were not filed properly or at all. The EOB helps me when I call and tell a provider I am not paying their bill yet. The EOB is the final word in all disputes.

If you know anyone that works with processing insurance claims, you know a person that deals with headaches every day! Busy medical practices file hundreds of claims each week so those individuals are up to their eyeballs in paperwork. And the sad thing is that reimbursements for services are down significantly, while the cost of insurance is up. You may have insurance but still have to pay a high price out of your own pocket when you see a doctor or provider.

I don't have all the answers to this problem. As a clinician I made some hard choices when I started practicing on my own. I decided to run a cash pay business. Its a novel idea - you see me and you pay me a set price for services. Just like when you go to a restaurant. You order and you pay the bill. I opted to do this because I cannot navigate the world of insurance. I am in the business of helping babies and their parents. Without the hassle of the insurance system I can provide my families with personal service. I can answer my own phone when they call or text. I can spend as much time with them as I please. I can schedule them quickly and at their convenience. I don't have to stay on hold with an insurance company for hours to find out what they think your baby needs. I spend that time with my own family. It means a lot less headaches for everyone. This type of fee for service is often referred to as Concierge care.

I'm attaching an instagram post from a PT in Virginia who sought out care for her newborn. She thought she was using her insurance as she went to an in network provider but unfortunately she still received a hefty bill months later. AND... she wasn't happy with the services she received. Lesson learned. Please feel free to contact me about concierge services so I can talk you through finding this out before its too late.