Is This Covered by Insurance?

Nearly every day, we are asked, “Do you take insurance?” or a similarly, “Is this covered by insurance?”

Working in the health care arena for over thirty years, I have watched the corporatization of healthcare delivery in this country. I’ve watched healthcare decision-making slowly taken away from physicians. I’ve fought against people who were more concerned with logistics and cost-savings than what is takes for nurses to deliver high-level patient care. I’ve listened to patients avoid or decline health care services, devices or treatments because they were not sure if  “this is covered by insurance” and afraid they’d be denied coverage.   Now, as a solo clinic owner, I’ve wrestled with the decision of whether to accept healthcare insurance or not.

Over the years, healthcare providers, across every specialty, have seen significant cuts and “claw backs” in reimbursement from insurance companies. These cuts come with added burdens of time-consuming paperwork, prior authorizations, “peer-to-peer” reviews, claim denial, form resubmissions, and ultimately, restrictions on how a healthcare provider can provide care. 

In the usual scenario, a practice will take measures to ensure their clinic doors can remain open, such as:

• See multiple (3-4) patients per hour, resulting in less face time with each patient, 
• Making treatment decisions based on what the insurance will pay, 
• Following the insurance company’s formulary and using the least expensive interventions that may not be as effective and have greater side-effects compared to newer or alternative options,
• Eliminate highly trained support staff and assign more responsibilities to lower-cost employees who lack specific training and education,
• Add on yearly practice fees to cover operating costs, etc.

The one thing these measures all have in common is that they all lead to changes in the care that a provider can deliver. 

Independent health care providers are quietly experiencing burn-out at the hands of insurance companies, the legal system, and over-reaching regulatory bodies. Providers keep jumping through all of the hoops to do everything right, but it never seems enough.

When a provider is unable to put the needs of the patient first because of a reimbursement rate that is embarrassingly low, and the time and energy to get reimbursed becomes too great, it makes sense that an independent provider would consider opting out of insurance and only provide out-of-network or cash-based services for their patients.

When Altasano opened in 2019, we started as a small, fee-for-service clinic in West Dundee, Illinois. Since then, the practice has expanded into its own building in Wonder Lake, Illinois. With the expansion, the question of contracting with insurance companies came up again. After thoughtful consideration, and based on the types of services that we provide, Altasano has started the process of contracting with the major insurance companies. Altasano Integrative will continue to be a fee-for-service practice for care that insurance will not cover, however we will begin to bill insurance for medication management visits and psychotherapy.  We are hopeful that this change will remove barriers to care for many, while still enabling us to provide the same high level of integrative mental healthcare.