Many new and prospective patients have asked why we can not bill insurance directly when other medical providers do. I fully understand the financial challenge this presents to some patients, and I wish there were a way for me to bill patients’ insurance companies. Unfortunately, at this time, there is not. In the following paragraphs, I explain why.

When medical practices bill health insurance companies directly, the doctors are required to become participating providers. The doctors must sign a contract that allows the insurance company to determine which services they will and will not provide and how much they can charge for those services. In general, insurance companies do not focus on preventive or wellness services. They invest heavily in the conventional model of health care that too often relies on drugs, procedures, and surgeries. As a physician who practices integrative and functional medicine, I am firmly committed to the prevention, wellness, and natural solutions to health problems. My goal is to address the underlying causes of your symptoms with specific nutritional and lifestyle recommendations — interventions that are generally not reimbursed by insurance companies.

A participating medical practice must agree to accept the fees the insurance company establishes, regardless of whether the prices are reasonable or applicable to that practice. In general, these set fees cover the actual cost of the briefest (and I believe the lowest quality) care. Doctors who are participating providers are required to accept discounted payments for their services, and they cannot bill the patient for the difference between their fee and what the insurance company will pay. Therefore, the practice must write off the difference, often as much as 50% or more of the doctor’s fee for service.

At the same time, the participating provider’s office overhead costs have to increase dramatically because of the staff, time, and equipment necessary for processing and tracking insurance claims. Most doctors and clinics cope with the requirements of being participating providers by keeping their office visits very brief so that they can see many patients within a given time frame. Our hourly rate is less than typically collected in a specialty practice. Still, the time is spent with you and not divided amongst 6-10 patients per hour. For example, a typical physician sees 99 patients per week and in 34 hours per week, at best, a 20 min visit for each patient. Per Medscape, the standard self-pay rate for an existing patient to a specialist is $165-240 a visit. Doing the math shows that even on the low end of that spectrum, $486 is the hourly rate. Ironically, some of my patients complain about their brief and disappointing office visits at other medical practices, while at the same time expressing frustration that I do not accept insurance or complain about our charges. Unfortunately, I have found that I cannot be a participating provider in the insurance networks and provide the time-intensive and well-researched care that I do.