The Value of Feeling Well Again
Is living a pain-free and healthy life worth what you would spend on a few nights at a nice hotel? Or how about all the money you pay-out in co-pays to doctors and the pharmacy? Go back and add up how much you’ve been spending. You may be surprised.
Then ask yourself if the treatment plan with your regular doctor is working. Are you connecting with your doctor or is he or she rushing you through another appointment? Here at the Center, we listen first, set goals, and then work together to achieve your optimum health.
We’re here to help you feel your best.
Do We Take Insurance?
Unfortunately, we do not bill insurance for services.
Currently, the insurance model for reimbursements are based on the complexity of disease: providers are paid according to how sick the patient can be documented; how well you are is not rewarded. Insurance reimbursement is not a time based model but a procedure based model of health care. For example: a 10 minute procedure can get 10 times more reimbursement than more than an hour of listening and processing root cause for a complex patient with chronic illness. We at the Center, will not compromise a reduction in time spent with our patients or increase diagnostic codes to gain more funding. We honor our relationship with you and will not be boxed in by how many diagnoses we can report or what procedures we can obtain to achieve the highest reimbursements.
We believe the right reimbursement strategy is to reduce the number of diagnoses and avoid unnecessary procedures and pharmaceuticals in order to achieve the highest level of health for the individual. Preventative Care should be the goal for everyone: the individual, the practitioner and the health insurance companies to help one to feel their best.
The Future of Medicine
“We are breaking away from the current medical-financial model that requires physicians to spend only ten to fifteen minutes per patient,” explains Dr. Stram. "We are a "time-based" practice, not a "volume-based" practices/insurance model of care".
“We believe this is the future of medicine, and we know more and more people are recognizing this with their willingness to pay out of pocket for consultations. We strive to set fair fees and to provide great value for the amount of time and care we take with each individual."
Will My Insurance Company Reimburse Preventative Care Services?
Most likely you will get a portion of your payment reimbursed if you have out of network benefits with your health insurance company**. Dr. Stram and his nurse practitioners would be considered "out of network" because they are not contracted with any insurance.
Many times there is a deductible that must be met before the health insurance company will reimburse for out of network services. The reimbursement rate is usually at 80%, Please check with your individual insurance carrier for your benefits. We recommend calling your insurance company to determine if you have out of network benefits and what if any reimbursements you are entitled to prior to making your first medical consultation appointment. Please also check with your insurance company whether you have out of network benefits for labs ordered by our medical staff and what the preferred laboratory is; our blood draw team will make every effort to send any blood work to the preferred lab.
Many health insurance companies are just starting to embrace the value of prevention, offering some benefit programs that allow for a certain number of wellness visits for services such as acupuncture and massage. Make sure you check with your own healthcare insurance company for newly added programs.
**Medicare: Please note that there is no out of network benefits for Medicare patients; Dr. Stram and his medical staff are non-enrolled/nonparticipants with Medicare. Patients with Medicare seeking medical consultations at the Stram Center do not have out of network benefits and are required to sign this acknowledgement at their visit; receipts cannot be submitted to Medicare or secondary insurances for reimbursement claims.
How Do I Submit For Reimbursement of Medical Services?
For consultation services* with the medical doctors or nurse practitioners, your receipts will have the necessary information to process a reimbursement claim, which includes the diagnostic and procedure codes for you to submit to your insurance company. If your insurance company also requires a claim form, please provide us with this form and our office staff will complete the medical portion for you to send in with your receipts.
It will be your responsibility to check for your reimbursement benefits and we recommend that you obtain this information prior to making your first appointment so that you have the reimbursement information you need to help make your decision to be a patient at the Stram Center. Please also check with your insurance company whether you have out of network benefits for labs ordered by our medical staff and what the preferred laboratory is; our blood draw team will make every effort to send any blood work to the preferred lab.
Often insurance companies will reimburse a portion of your claim, near 80%, if there is out of network benefits associated with your plan. Please call your insurance company for details.
The greatest number of requests for reimbursements comes from patients of complementary or integrative medicine; your demand for this kind of health care will steer insurance companies to make the change, just the way it did for chiropractic care not long ago.
*Please note, that naturopathic consultations in NY State are not covered by insurance as licensure of naturopaths in NY is still pending and there is no out of network benefits for medicare patients seeking consultations at the Stram Center--see ** above.
Will My Employer’s Flexible Medical Spending Account Pay For The Center’s Services and Prescribed Supplements?
Yes. Most if not all of our services should be covered under these plans.
You will need to check the details of your individual employer’s coverage. Supporting documentation may be required which our doctors can provide. Optimizing your health and well-being is a sensible way to spend your pre-tax dollars.