NON-COVERED SERVICES FEE
Upcoming changes at SIMC - Starting January 2024
Since 2009, the doctors and staff at Sage Integrative Medicine Clinic (SIMC) have been committed to providing our community with the highest quality medical care in a warm and welcoming clinic environment.
However, the rapidly increasing costs of running a small business in the greater Seattle area, increasing amount of time our providers and staff spend providing administrative and care coordination support services that are not billable to insurance (aka Non-Covered Services), and increasing costs of running a practice, have created a challenging environment for us to continue to provide the level of care and service to which we are committed.
Also, insurance has either decreased the level of reimbursement for our time spent with a patient or not increased reimbursement to match inflation within the last 10 year period. We also feel that it is extremely important to be able to provide our employees with a fair, living wage in Seattle so they are able to live here and provide quality service to our patients. This fee also enables our small clinic to be able to pay our amazing staff a fair living wage.
This has left us with the tough decision to either close our practice, move to a cash only practice, or to ask our community for support.
To address these challenges, we are making a change designed to ensure the continued longevity of the practice, without sacrificing patient care. First, we would like to discuss the growing issue of Non-Covered Services.
What are "Non-Covered Services"?
Non-Covered Services are all the administrative tasks performed on a daily basis that are not billable to insurance and are essential to providing you the best experience at SIMC.
On average, our doctors spend 10-20 hours a week each providing services to our patients that are not billable to insurance. These services are either not considered "medically necessary" by insurers or are not covered unless provided on the day of your visit.
These services are important, however, to providing the higher level of support our patients have come to expect and which best serves all of their needs. These Non-Covered Services consist of the communication, administrative work, and care coordination services we provide to ensure that you and your family are receiving the most comprehensive and holistic wellness care we can offer.
Examples of Non-Covered Services:
- Email messaging between doctors and patients per our messaging policy.
- Form completion between visits when appropriate, including, but not limited to: sports physicals, vaccine certificates, FMLA and disability paperwork, re-sending lab orders, prior-authorizations for prescription medication, imaging, and other medical procedures.
- Advocating for reimbursement for naturopathic services.
- Between visit troubleshooting of pharmacy, medication and lab issues.
- Between, pre- and post-visit reviewing of documents and communicating with other providers to help with continuation of care.
These services provided outside of the time limitations of an office visit are therefore done as unpaid for the providers and the clinic.
These Non-Covered Services are an important part of providing holistic, comprehensive care for you and your family. Rather than limiting these activities, we have decided to embrace them and more intentionally carve out staff time and resources to do them and do them well.
We have looked at this problem from every angle. We have crafted a solution and, in the process, gained clarity about what must be protected. We will:
- Continue to accept insurance and manage insurance billing for the patients we provide care for who would like us to bill their health insurance plan.
- Continue to provide affordable cash-pay options for people who do not use insurance to pay for their care.
- Manage our practice size and schedule to remain a "small practice" so we can continue to provide highly personalized care and schedule you when you need a visit.
- Remain committed to protecting the length of our visits, allowing spaciousness so that we can cover what is needed rather than joining the race, making each doctor move faster, seeing more people in less time, and cutting our visits shorter.
- Cultivate a clinic environment that allows us to be available to you during important medical milestones.
To do this, we need your help.
Starting January 15th, 2024, the clinic is asking all patients to sign a Non-Covered Services Agreement.
This Non-Covered Services Plan will cover the cost of administrative services we provide that are NOT billable to your insurance plan, in addition to non-covered facilities and supplies.
This is a hybrid approach, as we WILL continue to bill insurance as we always have for the health care services that they cover and will institute the Non Covered Services financial plan only for Non-Covered Services.
To be clear, this fee does not replace your Co-pay.
Non-Covered Services Plan: $35 per visit.
We will bill you at the time of your visit. Insurance will be billed for your office visit as usual.
Yearly Membership Plan: To Be Announced
We will be rolling out a yearly membership fee in the coming weeks that covers your entire year of visits.
How does this work if I pay cash for my visits and do not have SIMC bill my insurance or I don't have insurance?
If you are paying cash for your office visit at the time of your appointment, the amount of money we save by not having to bill insurance companies covers the cost to provide your "non-covered services".
For those for whom the non-covered services plan poses a financial hardship, please contact our office. We have a limited number of slots for which we can waive the fee for those in need.
We deeply value the relationship we have with each of you. This shift will help us preserve our ability to tend to you in a system that wants faster, bigger, more algorithmic healthcare when we KNOW that this time calls for the exact opposite.
Thank you for supporting us as we deepen our resilience and allow us to continue to offer you the independent naturopathic primary care you want and expect.
For more information visit www.sagemedclinic.com or call (425) 835-0359.
Yours in Health,
Dr. Angila Jaeggli
Note: If you have a Flexible Spending Account, you may be able to pay your membership fee on your HSA / FSA.