Insurance & Billing

Below we cover five items:

    1. Payment at time of your visit.
    2. Coverage of visits by insurance.
    3. The fees for different kinds of visits.
      (And different rates for doctor and nutritionist.)
    4. Details on fees for other services.
      This includes email and phone consultations, and more.
    5. Payment issues and collections

 

Payment

Payment is due at the time of the visit. You should submit to your insurance company for reimbursement if you have out-of-network coverage.

We take your credit card number when you register. (We use an ultra secure billing service. We do not keep your credit card number on file.

Medicare and Medicaid

Neither Healing Oceans nor Dr. Ginsburg participate in Medicare or Medicaid. Patients who are enrolled in them cannot be reimbursed by those programs for seeing Dr. Ginsburg, and must sign an affidavit of accepting this.

Insurance

Healing Oceans does not participate with health insurance company “networks”.

This means we are “out of network” for your insurance reimbursement. We do not accept their decision about how long the doctor should spend with you to address your issues, nor how much money they think it is worth.
(Insurance companies usually allow big dollars for surgery and drugs, but much less to figure out and address root problems. Dr. Ginsburg’s rates are among the most reasonable in the region for the work she does, but she spends more time with patients than most insurance companies allow.)

However –
Your visit will be covered by your insurance plan if it covers out of network visits. The amount that is covered is affected by two things:

  •  You need to meet the deductable of your insurance plan. No reimbursement happens with out of network care until you meet this.
  • The insurance company will decide how much of the charge for the visit is “reasonable and customary” (their term).(Dr. Ginsburg’s rates are  inside this “reasonable and customary” range.
    Since a holistic and integrative certification is a higher level of skill, such doctors usually charge more than that. In our area of the country, holistic family doctors generally charge between $350 and $600 per hour.)

Separating from the craziness of insurance plans was a difficult decision for Dr. Ginsburg because it would leave some of her patients without coverage to see her. Committted to being accessible by as many people as possible, she sets her rates where they are and created the membership plans described below for very young children.

She writes about the things she considered in making her decision, concluding it was something she must do.

 

Costs of Visits

NOTE: Occasionally a visit takes longer than expected, such as if a problem turns out to have a high degree of complexity.

Visits with Dr. Ginsburg
The following rates are effective July 1, 2016.

Our rates are within the “reasonable and customary” guidelines used by the insurance companies.

(For the nutritionist’s rates, click here.)

Type of Visit

Est.minutes(can
vary)

Cost

Initial Visit

60m to 80m

$300 to $400

Initial Visit for ASD
(Autism Spectrum) patients

80m or more

$400

 All patients receive an account  on an online portal that gives:

  • access to the doctor between visits using secure online messaging.
  • the availability of test results online, which may eliminate need for some follow up visits.
  • Efficiency by the doctor in processing data about your case.
No charge.
Well Woman Visit
This is much more than most doctors do in a GYN exam, and includes pap, breast exam, complete health review, and plan for ongoing health maintenence/improvement).

60m

$300

Well Teen Visit

60m

$300

Well Child Visit

40m

$200

Follow Up Visit

May run longer depending on complexity and amount of information to distill.
Times are estimates. Call us if you need clarity about your visit.

40m to 60m

$200 to $300

Follow Up Visit for ASD
(Autism Spectrum)

40m to 80m

$200 to $400

Urgent Visit
Related to illness or other urgent issue.

20m

$125

Procedures

40m to 60m

$200 to $350

Visits with Nutritionist Stephanie Goodman

Stephanie focuses on helping people understand their own nutritional needs, and supporting lifestyle changes to maximize improvements in health.

These changes are rooted in a new understanding of the impact of certain foods, of how to build a diet that meets your nutritional needs, of a new awareness of  food sensitivies you might not have suspected, of toxins in your body, paths to weight loss, etc.

Once you’ve met with her, her support continues to be available (in person or by phone,) to move you forward at your own pace.

Regarding insurance coverage for her, please click here.

 

Type of Package:
Nutritionist visits

time

Costs

Initial nutrition visits 60 min. est. $150
Subsequent nutrition visits

40 or 60 min

$120

Non covered tests: Why your insurance company does not pay for certain tests and treatments

If you have any kind of managed care plan like an HMO or PPO), most likely you are required by them to have all your lab testing done at a laboratory and testing company that has a contract with your plan.

Unfortunately, no laboratory company performs every test.

Also, holistic medicine today uses tests that other doctors (and insurance companies) often do not know about or understand. They use these tests to obtain more or different kinds of information than the conventional tests. One group of such tests is called functional testing, which report on the changes in a body over time, like a movie, instead of just the state at a particular moment (i.e. conventional blood test), which is more like a simple photograph.

For more on this, click on functional medicine testing.

What this means is that there are some tests you will have to pay for out of pocket. This happens regardless of how important you or the doctor think the test is. We have all heard the stories of patients having to legally fight their insurance company to pay for expensive tests that are covered under their policy.

The insurance company will still say that they pay for anything your doctor recommends be done, as long as it’s medically necessary. But that’s the catch. They get to decide what is medically necessary, not the doctor.

There is an exception:
If you have out-of-network benefits, usually you will get  reimbursed, at least partially.

Never covered by anybody:
Insurance will also not reimburse for any non-prescription treatment, including vitamins, minerals, herbs, nutrients, digestive aids, etc., regardless of how helpful they may be.
Lastly, insurance will also not pay for certain types of therapies, even if there is a ton of evidence that they will help your condition. Included in this list is acupuncture, massage, classes on stress management, rolfing, homeopathy. Many more.
Medicare:
Medicare does not use one particular lab. (There are only a few lab companies.) And they only cover certain tests, even if they are done in the labs they like.

Again, it does not matter what the doctor thinks will be beneficial to you, and it does no good to ask them. This system was designed by the insurance companies themselves. They are simply non-covered services to the insurance company, and the company prospers by finding ways to not pay.

Insurance coverage for our Nutritionist

For patients that see Dr. Ginsburg first, some of the visit to the Nutritionist may be eligible for reimbursement IF you have out-of-network coverage. .

Payment is made at the time of the visit.

Payment issues and collections

Nonpayment

  • Healing Oceans’ policy is that invoices not paid within 60 days are subject to patient dismissal and submission to a collections agency.
  • If we must remit your account to our collection agency, an additional 30% of the balance owing (including late fees of $5 per month) will be charged to your account.


NSF (bounced check) Fees and Collections:

  • If your payment is refused or bounces, you will be charged $30 and any bank charges incurred, and you are given 14 days to make payment. After that you are charged a late fee of $5/month.