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Functional Medicine Cost

Insurance Billing vs. Paying Cash

While we do not bill your insurance company for you, you are welcome to submit a claim [Superbill] on your own seeking reimbursement {We will fill this out and give this to you}. Before you do, please consider the following?

1. If you file a claim with your insurance company, all diagnosis codes and test results will go on file with your insurance company. This can be used to determine future premium costs for you and your family.

2. If your diagnosis includes a hereditary disease like high blood pressure, it will not only be seen on your health records, but also the records for your children and grandchildren and will be used to determine their coverage availability and premium costs.

3. Insurance companies are quick to raise premiums or drop coverage entirely when customers file too many claims, or just one of the wrong kind of claim. (ex. nutritional care, rather than the medical "drug-fix").

4. Your insurance carrier is responsible only for paying benefits covered under your policy and will deny anything they deem "medically unnecessary or experimental". Nutritional services frequently fall under this category and therefore are not covered which means you are supplying them with diagnosis codes, test results, etc. (which they can use against you) yet you see no financial benefit.

5. Rescission - if you have a serious illness, insurance companies will search your file to obtain medical records from the last several years and if they find any inconsistency in your application, your policy can be rescinded so they can avoid paying for costly treatments or medication. Any information you share with them could be used against you.

6. Preapproval - if you call your insurance company to find out if certain services are covered, it is a warning sign to your provider that bills are coming which may spark a rescission search on your account.

7. Your Medical Doctor may not be able to order all the tests we require in order to best serve you with Functional Medicine. Medical Doctors are required to follow very specific guidelines when order lab tests in the Medical Managed Care system which preclude them from ordering all the tests you may need.

8. Even AFTER your Medical Doctor orders all the tests we require to best help you, your Insurance Company may still deny your tests as not being Medically Necessary. In this case YOU are responsible for the bill that could be in the $1,000's.

If you have insurance coverage for functional medicine services, you can use the following form to submit
to your insurance company for potential re-imbursement.

Although you can fill this out yourself (or we can do it for you), the form MUST be signed by Dr. Otto

Superbill for Cash Services Rendered

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