A+ Athlete – Sports Medicine, LLC is transitioning to a more Direct Specialty Care Practice, and as of 7/1/23 will be Out of Network (OON) with private health insurance plans. We will remain in certain government plans: Medicare, some Medicaid, and VA (Veterans Affairs).
Our practice now will have a more direct relationship with you, our patients, with less anticipated insurance company hassle and interference. Due to ever increasing in-network administrative burdens, payment denials or only partial payments for services rendered, even takeback (or recap) of payment for services rendered months or years in the past, this has increasingly resulted in you, our patients, ultimately being responsible for and getting stuck with a large unanticipated “Surprise Balance Bill”. This has been in large part because of insurance plans often unusual and constantly changing policies towards payment of providers (e.g. doctors) for services rendered (to you, our patients). There often is lack of fair payment, lack of transparency, and hidden tactics like delays and inexplicable or irrational denials for services, and unpublicized sudden changes in what they may cover.
In addition, other in-network obstacles, such as drawn out and often failed or delayed prior authorizations for tests like imaging studies, tests, and procedures – can result in delayed evaluation and care, further lengthening suffering for you, and frustration for us in expediting your care. We anticipate and hope this process will be more streamlined in our new situation. After all, we are nationally medical board certified, and state licensed physicians – medical professionals with over 20+ years of experience treating patients, and treating them well … being noted as “Top Doctors” in several publications over several years. We (the true doctors and health care providers actually caring for you) know when it is necessary to order tests and treatments for you, our patients. Yet in-network insurances put up roadblocks to you getting the diagnostic workup and care you need from us, your chosen doctor or health provider, by often having cookie cutter inflexible rules or algorithms that impede the flow of a typical workup.
Among other bureaucratic administrative red tape, it really has become steadily more frustrating and quite challenging to operate and sustain a smaller medical practice like ours, to provide you quality care under these circumstances. We simply can not afford to have entire departments of staff to battle all these unnecessary hurdles to provide you quality care. Rather, we have a small team approach and it becomes all of our staff’s job to be aware of the process to help navigate you through the system which can be like a maze. Continuing this effort of battling the insurances, takes more and more of our resources away from caring for you, and directing them to jumping through often silly in-network insurance hoops.
However, just because we are now Out of Network (OON), this does NOT necessarily mean your insurance will not help pay for your visit! To the contrary, for most of you! Nor does it mean you must leave our practice! We want you to stay, or if you are new to the practice, to experience the quality and personalized care you will receive here. In fact, many private health insurance plans already offer you out of network benefits, of which you just may not realize. We encourage you to review your insurance plans and contact our billing department to learn what are your out of network benefits if you have questions. When you come to the office, we aim to minimize your upfront out of pocket payment at time of service, and make it as close to what you are used to paying when in network, so it is fair and affordable to you and us. In some cases it will be a little less, and other cases a little more, but many are comparable. With us no longer being bound by in-network restrictions, we have flexibility in fees and payments (and payment plans) and we will work with you to receive the care you can afford. Please speak to us if you are concerned about the finances. As noted, we still will be able to bill your insurance company on your behalf for services rendered to you (as an out of network (OON) provider), and we will work together to make sure fair payment for services is received, enabling us to continue to serve you with high quality care in a respectable manner for all.
We treat our patients here like family. We get to know a little bit about you. We are interested in establishing long term partnerships in helping you care for your health. We think of you as co-workers with the task of providing you optimal care. This is a form of Personalized Medicine, working together coming up with the best plan to get you better or optimize your body for your everyday movement activities, your fitness activities, and long-term health and prevention.
This was not an easy decision, and one that we have been carefully considering for several years, as the in-network insurance system has been eroding with respect to our practice.
We are providing a transition period during July 2023 in order to ease everyone into the new situation. Certain restrictions have limited us from having a longer lead time to alert everyone. Nonetheless, we will all work through it, aim for fairness, and look forward to continuing in the next phase of our practice helping you in your health goals for now and in the future.
Again, please do not hesitate to reach out to our Billing Staff for billing or coverage questions or our office staff for procedural questions. We are accumulating frequently asked questions (FAQs), and our staff is getting accustomed to being able to respond to such questions. Please be patient with us, as it is a transition for us as well.
Sincerely Yours in Health,
The A+ Athlete – Sports Medicine, LLC Team