Insurance Frequently Asked Questions

Tell me more about the insurance claim form

Although the form is called a superbill, this is just an accident of marketing. (The first company that sold this form thought it would sell more of them with a fancy name). This is the commonly used form to give your insurance company the appropriate codes for the services you received here and the reason we gave them. We keep a copy for ourselves and give you the original and a copy.

Exceptions to billing your own insurance company for services at our clinic

We do participate in the Washington State Labor and Industries program and will bill them for you.

We do not participate in any way in the Medicare program, Medicaid, Washington Basic Health (WBH), or other similar government programs. (CHAMPUS is an exception, and you can send a claim to CHAMPUS for services at our clinic.) As a condition of our non-participation, Medicare and WBH require that we give you no information that will allow you to send a claim yourself. This also means that you cannot send a claim to your Medicare secondary insurance.

If you wish to contract with us privately to provide medical services to you outside of the Medicare program, ask for a form at the front desk. At the time of payment we will give you a receipt for your taxes, but can give you no insurance billing codes.

Why are you concerned about Medicare fraud?

A colleague in Seattle, like us, does not participate in Medicare. This physician had been caring for a forty-something year old patient with a chronic illness for over a year. Then the patient informed our colleague, Dr. Lewis, that she (the patient) had gone onto Medicare a few months previously due to disability. Would Dr. Lewis please send the bills to Medicare? Dr. Lewis told the patient that she did not work with the Medicare program and would cancel the fees so the patient would not need to pay. The patient, in an effort to help Dr. Lewis, telephoned Medicare to ask them to pay the bills.

In the eyes of Medicare, to care for a patient without sending in a claim, even if no charge is made, is considered fraud. So, Medicare charged Dr. Lewis with fraud.

Dr. Lewis' policy was to have her patients over 65 sign an agreement that services were being provided outside of the Medicare program. Her problem arose because she had been unaware that her patient who was under 65 had joined the Medicare program.

Fortunately for Dr. Lewis, she had done some consulting for the Medicare program and therefore had some colleagues within the Medicare system. Some phone calls were made and charges were dropped.

Since learning of this, we require all patients to acknowledge that all services are provided outside the purview of the Medicare program.

Why did you leave Medicare?

Medicare says they will pay for non-covered services, and that we should bill the patient directly for non-covered services. However, it is impossible to know which is which, especially when we combine traditional western methods with more natural methods. The Medicare program does not encourage or pay for the innovative treatments that we use. When we did participate in the program, we found the rules capricious and changeable. For this reason we have ceased to participate in any way with the Medicare program. We do not provide services billable to Medicare or Medicare secondary insurance.

I have Medicare. How can I lessen my costs?

Many of our patients have Medicare physicians to provide their ordinary care, and consult us only for problems that require our services. We encourage you to let us provide records of your care here to your Medicare physician so that they are aware of your entire medical situation. We encourage you to obtain Medicare-covered services from a participating Medicare physician if that will help you lower your costs.

Why did you end your managed care contracts?

I consider myself fortunate to have become a physician. Each year brings more reward to my working hours. The science and art of medicine is a fascinating challenge. Working with the people who consult me is fulfilling. Because of all that, I hope to continue to practice for several more decades. To do that and maintain my equanimity, I've stopped dealing with managed care companies.

What role do you see for medical insurance?

Medical insurance is important to have for major medical expenses. Click here for more information.

3/5/04 L