How the office works: (FEES, INSURANCE, REIMBURSEMENTS, etc.)

       1. Ours is a fee for service office. Patients pay for their services on the date of service with     either credit cards, cash, or personal checks.  Personal checks may not be used on the            initial visit but may be used thereafter. Most patients use a credit card.

• Please call the office for current fee schedule, as rates are updated periodically.

   

  2. Our office is not a participant in any insurance panels other than Medicare. However, those with out-of-network benefits (typically it will say “PPO” on your card) will be able to submit a superbill we provide with a claim form and get reimbursed as per their coverage arrangement with their insurance company (e.g., 80%, 70%, etc.) We keep our fees aligned with what is considered “reasonable and customary” by insurance companies for the Bergen County NJ area. 

   Note: Given the kind of medicine we provide here, our office would not fit well into an insurance panel, as the insurance company would then dictate the length of our visits and the number of tests we order. Very few offices that provide functional medicine participate in insurance panels for this very reason, as an insurance panel would likely restrict the quality of personal, in-depth care we seek.to provide.

   

  3. Those who do not have any out-of-network benefits pay out of pocket as well on a modestly different scale and are still able to save their super bills for use when filing their income taxes as proof of medical expenses.

   

  4. Even for those patients who have no out of network benefits it is nearly always so that our panel of blood work sent to either Quest or LabCorp is indeed covered by insurance as these two labs are both participant in almost every insurance plan offered.  Our detailed and rather large panel typically runs anywhere from $7,000 to as much as $10,000. So, both those with and without out-of-network insurance get to utilize their plan benefits, such as they are, extensively.

   

  5. Our Medicare patients pay us directly at a Medicare dictated rate, and we then submit their claims electronically. Those who have Medicare plans other than the traditional government plan need to pay us out-of-pocket as well; they are then sent superbills much like non-Medicare patients, which need to be sent into their private plans by the patient to seek reimbursement.
  Medicare and any secondary insurance reimbursements then go directly to our patients.

   

  6. We do not participate in Medicaid, hence, do not submit to Medicaid. However, as a courtesy to our Medicaid patients, we charge them the Medicare dictated rate.

    

  7. Intake as a patient consists of three components: history, physical, and the ordering of tests, which we do together. All three must be completed prior to creating a plan of action.  Often, our patients’ histories are extended, and take an hour or more. Each visit is up to an hour long but not longer, to optimize insurance reimbursement for those who do have it. Therefore, many patients require an additional visit to complete their intake. Billing for each visit is based upon time spent.

   

  8. A credit card must be provided to hold an appointment, as we will be holding that full hour open in our schedule for the patient. The card is not charged or used in any way until the date of service, and patients may elect to pay in another way, and not use the card number provided at all  for payment.  Cancellations, or changes, must be made by the prior business day.  We are open on Tuesday, Thursday and Saturday, so, for example, a Tuesday appointment must be cancelled or changed by the Saturday before, which would be our prior business day. Late cancellations or failure to cancel will result in being charged a fee equal to half of the expected charges for the canceled visit. If you need to make a change, please remember to make it on time.

   

  9. It is recommended (but not required) that a patient write or type a brief, succinct chronology of their physical and psychological histories prior to coming and bring it with them. This would include anything that has happened of any significance from as early as possible (“I was in good health until…), positive and/or negative, treatments, etc. Not only does a written chronology reduce the time spent on history, but it also ensures that the history will be complete without leaving out important pieces inadvertently.

   

  10. We do make confirmation calls for each scheduled appointment on the business day prior, but occasionally we are unable to connect or leave a message. Patients are nonetheless responsible for their appointments and any necessary changes.
  
  

  We have made every effort to be transparent and clear and explain how the office works, and hope we've been successful. However, if you have questions after reading through this section, we invite you to contact the office on Tuesday Thursday or Saturday, our business days, or leave your message at (201) 525-1155 and someone will get back to you shortly and will be happy to explain further and answer any questions.