Medically Coded Invoices
Updated on 6-12-2014
Proactive Wellness Centers does not take insurance as a form of payment for any services. We do work collaboratively with patients to help them get partial reimbursements for treatment provided by the practice. We do this by providing medically coded invoices that provide the necessary treatment codes (CPT) and diagnostic codes (ICD-9) that insurance companies require in order to determine your eligibility for reimbursement under the “out of network” portion of your plan.
Note that if you are enrolled in an HMO or other “gatekeeper” type plans where you need a referral from your primary care physician, you will not likely be able to get any reimbursement for our services. If you have a PPO or other more “open” type of policy, you MAY get a partial reimbursement for some portion of our services. Note that beyond providing a medically coded invoice, that Proactive makes no promises of reimbursement of any particular amount for any service. This determination is made solely by your insurance company.
Patients should note that not all services rendered are eligible for medical invoices. For example, our providers spend time responding to patient inquires in our secure communication system and this is a part of what the program fees cover, but these services are not eligible for medical invoices. Accordingly, medical invoices (superbills) provided may be significantly less than what the patient paid in Program Fees. The medical invoices are intended to facilitate a partial reimbursement in cases where patients’ insurance provides out of network coverage.
Please note that medical invoices are provided for services and procedures. For patients electing to use our “cash”-based pharmacy for compounded prescription medications, we cannot provide medically coded invoices or claim forms for these purchases. The reason for this is that our cash-based pharmacy has provided much lower prices but they do not participate in insurance and cannot support insurance claims. If a patient prefers to use insurance, our physicians will move their prescription(s) to an insurnace-based pharmacy who will provide the medical claim forms, but understand that the prices are typically much higher. But it always the patient’s choice. The patient may either pay the lower prices with our cash pharmacy and accept that neither Proactive or the pharmacy can provide medical claim forms or opt for the insurance-based pharmacy where they will pay the pharmacy direct and be able to get medical claim forms, with the understanding that the prices are generally considerably higher. Further, from a practical perspective, patients will get little if any reimbursement for hormones and specialty medications even with a valid claim form as these medications do not fit the traditional reimbursement models. How do I get medically coded invoices for my visits?
Upon request, Proactive will provide medically coded invoices to its patients. Requests should be sent directly to our medical billing specialist at firstname.lastname@example.org. This is the most direct way to ensure that your requests are being processed. Sending requests to other mailboxes will likely cause a delay as your email will have to be forwarded. We are using a specialist to handle this so that our staff can support your medical concerns even more effectively in the future.
When will invoices be provided?
We will generally provide invoices by Friday of the week following your visit. If you have not received an invoice by Friday of the week following your visit, please send a followup email to the same address as above. Items requiring escalation may be sent to email@example.com.
Why do my invoice amounts not match what I paid?
The invoice amount for initial visits and non-program followup visits will generally match the amount you paid. For program-based followup visits, we have to follow a different procedure as insurance companies will not reimburse you for treatment that has not yet been provided. Thus for 90 day and annual programs, you will receive an invoice for each visit equal to our standard pricing for short and long visits, $225 and $325 at the time this document was created. We will provide invoices in those amounts based on your actual visits until the invoice total is as close to the amount you paid for your program as possible. We have found that this process provides the maximum reimbursement possibility for our patients.
Contact information for additional questions?
Please contact Cherice Turner, Medical Billing Specialist, for additional questions:
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