Your Wellness MD is quite unlike the traditional medical practice that takes place within the insurance model.
These FAQs will help you determine whether or not this practice is right for you and help you navigate our system once you have joined.
INSURANCE QUESTIONS -
Will my current health insurance pay for my monthly membership and telehealth visits? What about labs?
Your health insurance will not pay nor reimburse you for your membership or individual telehealth visits. Direct Primary Care is an alternative to the health insurance system where you pay for care directly via monthly membership.
Most insurance companies will pay for basic and routine labs ordered by Dr. B. We recommend paying for labs using her out of pocket negotiated rates when they are available as these often end up being much cheaper than going through your insurance company.
A CPT code will be available on all lab requisitions if you want to submit to your insurance for reimbursement. However, most insurance companies do not reimburse for specialty and functional medicine labs.
You said that my LabCorp labs would cost around $275 out of pocket, but my insurance company just billed me $3500! What happened?
Once you submit a lab order as an insurance claim, you are asking your insurance company to be the primary payer. It will then be processed as an insurance claim, and there is no way to revert back to Dr. B's negotiated out of pocket rates after submitting. Dr B. will not negotiate payment for you once a claim is submitted to your insurance company.
If an insurance company refuses your claim, they can and will charge whatever they arbitrarily choose. We've frequently seen insurance companies mark-up costs as much as 1250% above Dr. B's negotiated retail rate on lab orders. It can be very difficult if not impossible to get an upfront answer about what your insurance company will or will not cover ahead of time. It is even more difficult to get clear answers on the established retail costs for things they choose not to cover. But if you choose to use your insurance for specialty labs you must try to get these answers ahead of time.
For this reason we always recommend using Dr. B.'s discounted rates on LabCorp labs especially. For Func Med or specialty labs we typically recommend paying out of pocket first and THEN seeking a reimbursement if you choose. If you can't afford the out of pocket cost of a specialty or Func Med lab, you should probably reconsider ordering that lab.
Can you help me determine what my insurance will and will not pay for?
Dr. B. no longer has contracts with insurance companies. Prior to opening her Direct Primary Care and Functional Medicine practice, Dr. B. employed three people full time to manage insurance billing issues for visits, medications, labs and procedures. The main reason our membership rates are so low is that we have cut out the overhead required for dealing with insurance companies. Determinations on what your insurance company will cover or reimburse must be confirmed by you.
Can I pay for my membership through my HSA or FSA?
You will need to check with your accountant for what medical expenses are allowed within your HSA or FSA.
If you only do Telehealth how do I get an in-person exam?
We recommend that every client maintain health insurance and access to an insurance-based PCP. This way you can make sure you can get necessary screenings, vaccines and well check visits.
Things like pap smears, colonoscopies, prostate exams, necessary imaging and emergency visits are generally best accessed through your insurance company. You can also pay for these visits out of pocket.
COMMUNICATION & SCHEDULING QUESTIONS -
I know this is a telehealth practice, but I don't really like going online or checking email. Can I get around that?
No. In order to communicate appropriately with Dr. B. and your health coach you must feel comfortable navigating and using online platforms.
You must check your email regularly and respond to messages from Dr. B. and your health coach via Elation Passport. For texting and video chat we use, Spruce Health.
If online visits are an obstacle for you, or if you prefer in person visits, then you should probably find another provider.
You have so many online portals, I don't understand which is which.
If we could find ONE platform that had all the functionality we needed, believe us, we would use it! We use THREE HIPAA compliant, integrated platforms here at Your Wellness MD:
3) Hintis our online billing platform. Use it to update your payment method, get a record of payments, or cancel your membership.
When you SIGN UP for a membership through HINT, Dr. B. will send invites to Spuce and Elation Passport. You can also sign up for all of these platforms when scheduling your first appointment with Dr. B.
How do I make an appointment?
Also, I am confused about AZ time versus "Mountain Time."
Dr. B's scheduler takes place in "Arizona time" where she resides. In order to accurately schedule appointments, you must look up "AZ time" on your search engine or cell phone. Arizona essentially has its own time zone, because it does not follow Daylight Savings. Arizona is always on MST and never on MDT. Unfortunately Google simply refers to MT in general.
Practically speaking this means that part of the year AZ time aligns with PDT, and the other part of the year it aligns with the rest of the Mountain States on MST.
It says I can have "unlimited access" via text and email and "unlimited telehealth appointments" with Dr. B.
What does this mean?
You can schedule appointments with Dr. B. as you feel they are necessary. Generally Family Medicine/DPC patients will see Dr. B. once per month or less and Functional Medicine patients will see Dr. B. every two weeks. Dr. B. schedules both 20 and 50 minute appointments after her initial consult.
Please do not use Spruce, the texting platform to ask extensive questions about your health, testing or your protocols. If it's more than a few sentences, write Dr. B. an email on Elation. If it's more than a paragraph, make an appointment to discuss your concerns with Dr. B. Usually Dr. B. responds immediately, but please allow between 24-48 hours for a written response.
You are responsible for making as many appointments as you feel you need to get the most out of your membership and your healing journey.
GENERAL QUESTIONS -
Where do you send my lab requisitions?
Where do you send my test kits?
Your lab requisitions are posted in your Elation account. You can print them out and bring them to any lab of your choosing. If you would like Dr. B. to send the lab requisition directly to a specific lab, please provide us with their fax #.
We order labs in over 3 states. You cannot show up to a lab without a requisition, or without having previously providing us a fax number and expect that lab to have your order on file.
We will send your at home test kits to the address on file (the one you used when you signed up with Hint). If your mailing address is different than the one you provided, please email or text Dr. B. and she will update it for you.
Do I have to take supplements?
No. Your compliance with our protocols is always your prerogative. However, the primary tools that we use in this practice are advaced diagnostics, nutraceuticals, lifestyle medicine via coaching and appropriate and conservative use of pharmaceutical medications.
In general, it is difficult to make progress without following our recommendations.
Where can I get my supplements?
We strongly recommend ordering your supplements and neutraceuticals via Dr. B.'s Fullscripts account.Fullscripts ensures quality control direct from the manufacturer and validates the ingredients and amounts stated. Most high quality brand supplements on Amazon.com and elsewhere on the internet are counterfeit and do not contain what they say. The supplement market does not require FDA oversight, and most "cheaper" supplements do not contain what they claim.
Memberships and out of pocket labs just seem so expensive. Do you offer a discounted rate?
No. We have streamlined our operating costs to be as minimal as possible in order to provide our services at the lowest possible rate. We always pass any discounts on labs or imaging to our clients and never upcharge.
Ideally, clients in the Func Med program should be prepared to pay for 6 months of membership PLUS $1000 - $3000 in laboratory costs. If that amount feels financially overwhelming, then this program is likely not appropriate for you at this time.
DPC members should not expect access to functional or specialty work-ups as part of their program as these are investigations are more labor intensive for the provider.
I was busy and unable to use my membership last month. Can I get a refund?
Can I pause my membership and restart it?
No. We have priced our membership model based on a concept of continuous care, available to you whenever you need it. Membership in our program guarantees that we are available to you when you need us.
It is common for a client to have a month or two with little to no contact with Your Wellness MD. You can always use our services more heavily the next month or whenever you need more support.
No. You cannot stop and restart membership, except under rare circumstances determined by Dr. B. Our pricing is based on a yearly estimate of general usage over the course of around 5 years. If we let every client stop and start membership according to their individual usage needs we could not sustain our low cost membership model.
I am clear that I cannot continue my monthly membership. How can I cancel?
The best way to cancel is to make a final appointment with Dr. B. so that she can review her most important recommendations for your health and healing going forward. During that appointment she can also cancel your membership.
Your Wellness MD is dedicated to achieving meaningful, measurable improvements in your health and well-being. We work to ensure that you have access to the care you need, when you need it, at a price you can afford...