Payment & insurance
Dr. Davis operates on a blended membership and fee for service model. She does not participate with any insurance companies.
She has very mindfully chosen this payment system so that she can focus on excellent quality, personalized care, and a deeper relationship with her patients. By cutting out the middlemen, and remaining out-of-network, she can collaborate with patients to make health decisions without interference from insurers.
The insurance model perpetuates the "quick fix" approach, putting out the biggest fire without allowing time to sort through the bigger picture or get down to the root cause.
Ultimately, it comes back down to Dr. Davis' belief that you should be the ultimate decision maker for you and/or your children, not your insurance company.
So what do I do about my existing insurance?
Insurers are still important for everything outside of Dr. Davis's office. They play their originally intended role by covering emergencies, severe illness and catastrophic matters. With PPOs, they also generally cover labwork, prescriptions and often some portion of visit fees (subject to the specific terms of each policy, of course).
(Insurance in general is intended to protect you from catastrophic events, not preventive and routine matters. For example, your auto insurance kicks in if you are in an accident, but you don't use it for your oil changes or 100,000 mile tune-up. Your homeowner's insurance kicks in if a tree falls on your roof, but not if it needs re-shingling.)
Read on for more specifics about the different types of insurance you may have, and how it may interface with Dr. Davis' membership.
Private Insurances
Patients with any insurance can enroll in the practice, but your insurance plan is between you and your insurance company. Dr. Davis does not contract with any insurance plans, and is therefore considered an "out of network provider."
PPO's and some EPOs tend to work best with this model. After you pay for a visit provided by Dr. Davis, you receive a superbill (receipt with insurance codes) that you then submit to your health insurance company. Your insurance company then determines your reimbursement based on the terms of your plan. You will continue to give your insurance information as usual to any laboratory, specialist office, or hospital for services outside of the practice.
HMO’s usually require you to have an “in network provider” for outside referrals to be covered. This may include all labs, tests and specialist referrals. Be sure to check your plan’s details regarding their practices, as this is your responsibility. In these situations, it may be better to see Dr. Davis on a consultation basis rather than for primary care.
The annual or monthly membership fee itself is not covered by any insurance or HSA. It may be possible to use Flexible Spending Accounts, but check with your particular plan.
Medicare
Dr. Davis is "opted out" of Medicare. Patients with Medicare are welcome to see Dr. Davis for consultation, but Dr. Davis is not contracted with Medicare. Any services provided by Dr. Davis are not covered and not reimbursable by Medicare due to federal regulations.
This means that you will need to sign a private contract and pay out of pocket. Services ordered by me, such as prescriptions, will continue to be covered by Medicare, as long as you are not enrolled in a Medicare HMO plan. You must find out the rules of your particular agreement.
Medicaid
Dr. Davis does not participate in Medicaid. Patients with Medicaid are welcome to join the practice, but Dr. Davis does not accept Medicaid payments. There are a limited number of scholarship memberships, which are full at this time. Please contact Dr. Davis if you are interested in discussing your situation and being placed on a waiting list.
Uninsured
Dr. Davis hopes that patients without insurance will find her practice a refreshing change. The fee schedules are designed to make primary care affordable and accessible to everyone, insured or not.
Questions about how this would work for you?
Schedule a free introductory visit to discuss with Dr. Davis!