Non Covered Services Plan Options

Upcoming changes at NSNM

 

Since 2011, the doctors and staff at North Seattle Natural Medicine (NSNM) 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 Metro 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. This has left us with the tough decision to either close our 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 things we do on a daily basis that are not billable to insurance and are essential to providing you the best experience at NSNM. On average, our doctors spend 10-15 hours a week 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 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.

 

At NSNM, we offer comprehensive, integrative, naturopathic primary care medicine. Doing so takes time, mindfulness, and resources that are incongruent with the current insurance model. We have found that we spend a sizable portion of each day providing "Non-Covered Services", and that doing so has begun to affect our ability to keep the clinic operating. These Non-Covered Services are an important part of providing holistic 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 people 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 quickly 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.

 

  • 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 1st, 2023, the clinic is asking all patients who see Dr. Lush or Dr. Sinclair to sign up for a Non-Covered Services Agreement financial plan. For those who elect not to see Dr. Sinclair or Dr. Lush, your care will be transferred to one of our other NSNM providers, of your choice, who will be ready to help you continue your health journey. Doctors Lush and Sinclair will be available to your new provider for consultation.

 

 

This Non-Covered Services Plan will cover the cost of administrative services we provide that are NOT billable to your insurance plan, and the Deluxe Plan offers you valuable discounts on non-medical wellness and cosmetic services, 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, and, under the Deluxe Plan, the cosmetic and wellness discounts.

 

 

Elemental Non-Covered Services Plan:

 

$30 - per visit.

 

This plan is ideal for patients who only see us once or twice a year and rarely need Non-Covered Services outside of your office visit. We will bill you the month of your visit and will include 30 days of Non-Covered Services within one month of your visit.

 

Insurance will be billed for your office visit as usual

 

 

Deluxe Non-Covered Services Plan:

$20 I month or $200 annual fee if pre-pay in Jan 2023 (a $40 savings).*

$10 I month for each additional family member or $100 annual fee if paid in full in January 2023 only.

 

* No refund for cancellation or partial month or year.

 

Maximum family fee is the cost for 2 family members (example first family member is $20 / month, second is $10/ month, all additional members in your household included, whether you pay all at once or monthly.

 

Insurance will be billed for your office visit as usual

 

Deluxe Plan Benefits:

 

  • 10% off all supplements purchased at NSNM. All supplements purchased at NSNM are tax free, making them, with this discount, 20% less than supplements purchased elsewhere.

  • 15% off microneedling

  • $10 Rejuvenation room visits ($25 value)

 

 

You can find a copy of the Non-Covered Services Agreement HERE

 

 

How does this work if I pay cash for my visits and do not have NSNM 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". You can however opt in to the Deluxe Plan if you want the cosmetic and wellness discount benefits it provides.

 

 

Please call or email the office to sig up by January 2023 to receive the best price. If you choose to sign up later in the year, note that there will not be an annual pre-pay discount available. After March 1, 2023, enrollment for the Deluxe Plan will close and the Elemental Plan will be the only option available. In addition we will likely be limiting the number of patients who will be able to see Dr. Sinclair or Dr. Lush, so signing up early is encouraged to secure a spot on their panel.

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.northseattlenaturalmedicine.com or call us at (206) 629-5180. Yours in Health,


If you have a Flexible Spending Account, you may be able to pay your membership fee on your HSA / FSA

Palm Trees

 Deluxe plan

$20 / month or $200 annual fee if pre-pay in Jan 2023 (a $40 savings).

 

Insurance will be bill for your office visit as usual

Benefits include: 

  • 10% off all supplements purchased at NSNM. All supplements bought at NSNM are tax free, making supplements bought at NSNM 25% less than those bought elsewhere. 

  • 15% off microneedling 

  • $10 Rejuvenation room visits ($25 value)

$10/ month for each additional family member or $100 annual fee if paid in full in January 2023 only. 

 

Maximum family fee is the cost for 2 family members if you pay all at once or monthly. 

Elemental Plan
$30 per visit
 

This plan is ideal for patients who only see us once or twice a year and rarely need Non-Covered Services outside of your office visit.

We will bill you the month of your visit and will include 30 days of Non-Covered Services within one month of your visit.

Beach Chairs
 

Do I have to have a join a Non-Covered Services plan in January 2023?

--If you would like to see Dr. Lush or Dr. Sinclair you will have to pick one of the plan options as of January 2023. Both doctors have both been practicing nearly or over 20 years and are in such high demand that we feel this is the best next step for their practices to continue to provide high quality personalized healthcare.  Primary care medicine requires extensive time spent outside of the office visit doing refill requests, prior authorizations, medical records requests, and coordination of care with your other medical providers. This work is almost never covered by insurance and in order to continue to provide quality care, we are charging the Non-Covered Service plans to help cover this time spent by our doctors and staff that is not billable to insurance. They are not applicable towards your insurance coverage for any office visit, deductible or copay- those costs will remain the same. 

 

Can I see another ND if I do not want to sign up with a plan with Dr. Lush or  Dr. Sinclair?

--Just like with any patient switching care at NSNM, the ND that you will be seeing have full access to your prior doctor and we work hard to coordinate your care.  We do have 3 other exceptional NDs who will not be participating in the monthly plans. Neither of our acupuncturists will be participating either. 

 

How many patients will be members of the Drs. Lush and Sinclair?

--The physicians will limit the number of patients according to how many sign up. But the goal is that they are able to have smaller practices with more focus on the patients who have joined. However, the elemental plan is a pay as you come in so those plans should typically always accommodate patients as long as the physicians' schedules do not fill too fast. Signing up earlier in the month of January 2023 is recommended though to ensure your spot!