What is an integrative or functional medicine approach to treatment?
How are physician appointments done?
For detailed descriptions of how initial evaluations and follow-up appointments are done for each physician, please refer to each physician's forms in the section below.
Can patients be seen by other physicians once they have done their initial evaluation?
Practitioners at HeartLight care for patients with complex medical or behavioral/developmental issues. We feel that care is best provided by the physician who did the initial evaluation who knows the in-depth history and the subsequent course of the individual’s response to treatment. Therefore, the physicians at HeartLight do not treat each others’ patients, other than covering for times when physicians are out of the office due to vacation, illness, etc.
Do you provide primary care services?
It is important to note that physicians at HeartLight do not function as your primary care physician. You or your child must have and maintain a primary care physician in order to be followed by the physicians at HeartLight. We function as specialty consultation physicians. We are glad to work in conjunction with your primary care provider in order to coordinate and facilitate your or your child’s care
Do you accept insurance?
Practitioners at HeartLight Healing Arts do not participate with any insurance plans. Payment is expected at the time of service, regardless of whether your insurance company reimburses your visit. We do not file forms directly with insurance companies; this is your responsibility. We will provide you with invoices which include all standard information you will need to submit your claim directly to your insurance company (such as CPT codes, ICD-9 diagnoses and codes, etc.) Please be aware that some of the services provided may be “non-covered” services or not considered “reasonable and necessary” under your medical insurance.
Do you participate with Tricare?
Practitioners at HeartLight do not participate with Tricare. If you have Tricare insurance, per Tricare’s instructions, you will need to sign a form indicating that you understand that we do not participate with Tricare and that you will not submit bills to Tricare.
What forms of payment do you accept?
We accept cash, checks, and Visa or Master Card credit cards. Payment is due at the time of service.
What is your cancellation policy?
When a patient cancels shortly before an appointment or is a “no show,” we miss the opportunity to provide care to other patients who may have been able to use that time slot. Therefore, appointments (in-office or phone appointments) must be cancelled 24 hours in advance. Cancellation needs to be done within 1 business day. For example, if your appointment is on Monday, the appointment would need to be canceled by the preceding Friday. Appointments not cancelled within this time period (or patients who fail to show up for a scheduled appointment) will be billed for missed appointments at the following rates:
For physician appointments: $50.
For therapists and other practitioners: 100% of the cost of the appointment.
We understand that medical emergencies and other unforeseen events may occur; exceptions may be considered on a case-by-case basis.
To cancel an appointment, please call 410-880-4215 or 1-877-641-8472, extension 0.
Do you do phone appointments?
Phone appointments may be done for established patients (e.g., to discuss lab results, follow-up of treatment, etc). Payment must be made by credit card at the time of the appointment. The cost for the phone appointment is prorated based on the practitioner’s hourly rate. Please note that phone appointments are generally not reimbursed by insurance.
Do your practitioners use e-mail?
Not all practitioners at HeartLight communicate with patients by e-mail. If your practitioner chooses to do so, please be aware that e-mail is not to be used for urgent or emergent issues. E-mail communication is viewed as billable time, as is an office visit or telephone consultation. Brief e-mails may not be billed. However, frequent e-mails will be cumulative and will be billed on a monthly basis based on the time required to respond to your e-mails. Billing will be prorated based on the practitioner’s hourly rate. Please note that e-mail correspondence is not covered by insurance.
EXPLANATION OF OUR TRICARE POLICY:
We are not currently accepting new Tricare patients. The reasons for this decision are described below.
HeartLight practitioners currently do not participate with Tricare at all. This means patients cannot submit any of our bills to Tricare for reimbursement. It also means we may not be able to order lab tests unless a patient's primary care physician through Tricare is willing to help order tests under their name and/or a patient is willing/able to pay out of pocket for testing.
We had wanted to see patients who have Tricare insurance and assumed Tricare offered out-of-network benefits in the same manner as other insurance companies. Unfortunately, this is not the case. We spent many, many hours on the phone with numerous Tricare representatives clarifying their policy, including having our practice's attorney speak with them, as their policy is very confusing. The explanation below is our understanding of Tricare's policy and how it affects patients wanting to receive services at HeartLight.
• Tricare offers two ways practitioners can affiliate with Tricare - as "participating providers" and as "non-participating providers." Participating providers must accept Tricare's rate as full payment for services provided; this rate is too low for the length and complexity of services provided in a functional medicine practice. "Non-participating providers" can elect to not accept this minimum. However, even when not "participating," practitioners are still limited in their charges to 115% of Tricare's usual rate. Practitioners are not allowed to bill above this rate and have patients submit bills to Tricare to get payment back to themselves for Tricare's baseline rate (so-called "balance billing.") The only way to not be held to limitations on fees for service is to be completely disconnected from Tricare.
• In most insurance plans, non-participating means the provider is "out of network." This is not the case with Tricare. There is no comparable out of network situation in which we can bill our regular fees and have patients submit these higher bills to Tricare to get some portion back.
• Tricare also informed us that patients choosing to see practitioners not affiliated with Tricare would need to sign a legal form that explains the limitations described above and indicating that they understand they cannot submit bills for reimbursement.
• There has also been significant confusion about whether we can order tests if we are not affiliated with Tricare. To our understanding, we cannot order tests and have either patients or labs submit bills for these services to Tricare. In the past, we have asked the patient's primary care doctor if he/she will order blood tests we recommend. Primary care physicians have varied in their willingness to order traditional testing such as blood tests.
• For some non-traditional testing such as specialized urine or stool testing, some labs (e.g., Great Plains Lab, Genova Diagnostics Lab) contract with Tricare or have varying degrees of coverage depending on your type of Tricare plan. In our experience, it is very hard for patients to get a reliable answer from Tricare or the labs themselves prior to ordering the test regarding whether all or part of the test would be covered. This could result in significant financial cost to a patient. In addition, we were recently informed that we may not be able to order those labs as non-Tricare physicians. The cost of these labs can be significant (hundreds of dollars) depending on what tests are ordered.
• This means that all office appointments (initial evaluation, lab result discussion, follow-up appointments) could not be submitted for reimbursement and we likely would not know what labs would be covered, if any, in advance of the appointment. We appreciate this makes this a potentially large expense that is likely not feasible for many patients. We sincerely regret this situation but despite our best efforts and time spent trying to find a solution, we were not able to find a mechanism by which we could charge our usual fees and have patients be able to submit their invoices for personal reimbursement. The newer limitation on our ability to order lab tests further compromises our ability to provide cost-effective care to patients.
For names of other functional medicine providers in the area who may participate in some fashion with Tricare, please feel free to contact our office at 1-877-641-8472, extension 0, and we will be glad to provide any information we have.