Insurance

Dr. Ose is not a participating physician in any insurance company plans. There are two main reasons that Dr. Ose does not accept insurance. The most important reason is that insurance companies, by deciding for you as a patient which treatments you will be reimbursed for, interject themselves between a doctor and patient. For my patients, I want you to have full access to the vast array of safe, effective treatments available and for us to decide based on your health needs what combination of different treatments will optimize your overall mental wellness. The second reason is that for services the insurance company does cover which may be provided by physicians, the physician is often reimbursed by insurance companies at a much lower rate than what is fair market value for the service being rendered.

This second reason is significant in that you may be able to have insurance partially cover services received by me. I will either hand you or mail you a receipt at the end of each month which you can submit to your insurance company for reimbursement. As with going to any out-of-network provider, you will often get some reimbursement from the insurance company, but it is possible for certain services and treatments you will not get any, especially for many of the alternative treatments. Reimbursement also depends on which insurance carrier you have as well as your plan with that insurance company. I will either hand you or mail you a receipt at the beginning of each month for the prior month which you can submit to your insurance company for reimbursement. As with going to any out-of-network provider, you will often get some reimbursement from the insurance company, but it is possible for certain services and treatments you will not get any, especially for many of the alternative treatments. Reimbursement also depends on which insurance carrier you have as well as your plan with that insurance company. For individuals with Medicare Insurance (even as a supplemental or secondary policy), you will be required to sign a “Medicare Private Contract” in order to receive treatment at Holistic Mental Health, PLLC and you will not be able to submit claims for any reimbursement with Medicare.

TO OBTAIN INSURANCE REIMBURSEMENT, FOLLOW THESE STEPS:

1. I will provide for you a written statement at the end of each month to show that you already paid at the time of each visit, with all the appropriate codes.
2. This statement can be sent to your insurance carrier for reimbursement directly to you (though typically not for the full amount). You simply need to fill out your own insurance form, attach the monthly statement I provided to you, and send these forms to your insurance company.
3. Specify on your form that your insurance should pay you, not the doctor. If there is no place to specify paying you rather than the doctor on your form, then write the following (in red), somewhere on your insurance form: PAY SUBSCRIBER, NOT PROVIDER!
4. In the event that your insurance company sends me a check, despite your efforts to follow the above directions, I will sign it over to you, since you will have already paid me.

FIVE TIPS TO IMPROVE YOUR INSURANCE REIMBURSEMENT:

1. Check with your insurance company prior to seeing me to determine if there is a pre-authorization requirement for mental health services. I will be glad to assist you in filling out any paperwork if necessary.
2. Keep a copy of the monthly written receipt provided by me in case the insurance company loses your claim.
3. Promptly (within 1-2 weeks) submit your monthly written statement from me and insurance claim form to your insurance carrier.
4. Use generic medication if available. Generic medication has the same bioequivalence (it works just as well) as brand name medication, is cheaper to produce because research and development costs are not present (which helps keep overall healthcare costs lower), and is more likely to be reimbursed by your insurance company.
5. Ask your insurance company if any ancillary providers (massage therapist, acupuncturist, exercise coach, dietitian) are in-network as I will sometimes refer patients to see one of these providers.