6709 S Minnesota Ave Ste. 205Sioux Falls, SD 57108605-271-1020
Why Direct Pay Is For Your Benefit
We at Mary Wuebben Wellness are very passionate about what we do – we have been called to provide as many people as we can with the highest quality health care possible. Our services are unique to this region, as are our financial policies. We have prepared this information to answer some questions you might have about the rationale for our financial policies. If you have further questions, feel free to speak with our staff!
Why We Do Not Accept Insurance
Many people have contacted our office and asked us why we do not bill insurance directly or allow for patient-submission of claims, while other medical or chiropractic providers do. We understand that this may provide a financial challenge to some patients, and if there was a way for us to bill your insurance company we would, but unfortunately, this is why we cannot:
When clinics bill to health insurance companies, doctors/providers (MD’s, NP’s, PA’s) are required to become participating providers. These providers must sign a contract that allows the insurance companies to determine which services they will or will not provide. It also allows the insurance companies to dictate how much they can charge for services. Insurance companies, in general, are not focused on preventative or wellness services, but rather are invested heavily in the conventional model of emergent treatment and symptom management, which more often than not relies heavily on pharmaceuticals and surgery. We at Mary Wuebben Wellness are committed to the functional medicine model that focuses on the root cause of illness and promoting optimal wellness. We focus on patient-specific nutritional and lifestyle recommendations in conjunction with conventional and alternative therapies/services.
A participating provider with an insurance company must accept the fees that each insurance company establishes, whether reasonable or applicable to the practice. Often these established fees cover very little of the actual cost of service (covering only the briefest, lowest quality of care). This dictates a model based on high patient numbers (rather than patient care) that most conventional practices must follow to survive. Providers who participate are then required to accept discounted fees and cannot bill the patient for the difference between their own fee and what insurance will reimburse – the clinic then writes off the difference, which is often upwards of 50%. At the same time, participating providers’ overhead costs are steadily increasing due to the necessity of having staff to help with coding, billing, processing and tracking these insurance claims.
In today’s healthcare environment, the cost of providing services continues to rise, while the fee percentage that insurance covers for these services continues to decline. At the same time, the profits from health insurance companies as well as the salaries of their top execs continue to rise to record levels.
Most clinics and practitioners cope with the requirements of being participating providers by keeping your office visit brief, in order to increase the number of patients seen within any given time frame. When this fails to become profitable, it must be supported by another institution. Most medical clinics in primary care are not self-sustaining financially, therefore most have either merged or been bought out by hospital systems whose pricey surgical and diagnostic equipment and procedures help to keep clinics financially afloat. Ironically, many of our patients complain about their extremely brief and unsatisfactory office visits with conventional practices, while at the same time expressing frustration that we do not accept insurance. Unfortunately, we have come to the determination that we cannot continue to be participating providers in the insurance networks and at the same time provide the time-intensive, well-researched, expert care that we do. For this reason, we offer Direct Pay: we accept payments via cash, check, debit or credit card. We are also able to accept Health Savings Accounts (HSAs) or Flexible Spending Accounts (FSAs) for office visits as well as in house lab-draw and external lab kits.