Insurance

Why doesn’t Dr Prince take insurance?

 

This is a good question! If you do have health coverage, you may be wondering why our practice doesn’t just submit claims through your plan, especially since many people have traditional insurance. Because medical insurance providers can make things mystifying even at the best of times, we thought it would help helpful to explain the reasons why we do not accept insurance directly. 

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Drawbacks of Accepting Insurance

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Two of the things we are most committed to offering at the practice are:

1. The ability to meet with Dr Prince quickly (usually within 48 hours) 

2. Thorough appointments where all of your questions and concerns are addressed and you leave with a comprehensive treatment plan designed to help your baby feel better 

 

The problem with contracting with insurance companies is that it will make it very difficult- if not impossible- to achieve the above goals. If you’ve ever been referred to a doctor only to be told the next appointment is 6 months away or if you finally see a specialist only to get 10 minutes with them before they are rushing off to the next patient- this is the likely reason why. 

 

Accepting private insurance as payment would mean that we would have to contract with a medical billing company that could take anywhere from 6% to 12% of costs. We would also have to hire a separate employee who would have to track down payments from the insurance company and send bills to all of the patients for the amount the insurance company doesn’t cover or applies to their deductible. Dr Prince would need to see more patients, and spend less time with each patient, in order to cover the added cost of hiring another employee.

 

Additionally, we would need to charge higher prices. Insurance companies each pay different amounts for each service and clinics usually price services high to ensure that they can get the maximum amount of reimbursement from each insurance company. Unfortunately, because many insurance plans have high deductibles or large co-pays, this could mean that some patients end up spending more in the long run. 
 

Accepting insurance would also mean involving a third party in your child's medical care- the insurance company. When a third party, such as a health insurance company, becomes involved in patient care, the insurance company’s main interest is to pay as little as possible for the treatment of your baby's health-related issues. While insurance companies have the right to make a profit like anyone else, there are certain ethical boundaries to be considered.

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Because the insurance companies want to make as much money as possible, they may go beyond their scope of expertise to make that happen. For example, they may require your little one to have unnecessary testing done — testing that won’t give us the answers we need — in order for them to consider approving a more advanced and costly type of treatment plan that your child needs. This approach may create delays in obtaining an accurate diagnosis and/or treatment plan.

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While we not take insurance directly, what we can guarantee is this:

 

• All consultation fees are available to the public and are not arbitrary. We have also created a subscription option for follow up appointments to help make them as affordable as possible while still delivering the level of care your child deserves.

 

• You are not likely to wait long, if at all, to meet with Dr Prince. Some families have even had same day appointments. We do not double book appointments.

 

• We maximize the time you spend with Dr Prince. As long as you arrive for your virtual appointment on time, you will spend about 50 minutes face-to-face with her so that you will be the consultation feeling confident and reassured about the treatment plan we have agreed on. Following your appointment you will also have a month of support available through our dedicated patient portal.

 

If you have out of network benefits, you will also have the opportunity to submit a claim for reimbursement following your appointment. The practice can assist with providing any information or CPT codes you’ll need for this process.