Non-Covered Services

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 visits sending in pharmacy refills

• Between visit reviewing of documents and communicating with other providers to help with continuation of care.

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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, 2024, the clinic is asking all patients who see Dr. Lush,  Dr. Sinclair and Dr. Tausend to sign up for a Non-Covered Services Agreement financial plan. For those who elect not to see these doctors, 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. Doctor's Lush, Sinclair and Tausend 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.

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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 2024 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, 2024, 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 the doctors on this plan, so signing up early is encouraged to secure a spot on their panel.

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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.

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