Frequently Asked Questions
Langeloh Family Healthcare is a Direct Primary Care practice with an interest in providing low cost quality healthcare. Healthcare for you without the hassle of insurance co-pays, deductibles, and authorizations. No more time constraints on providers for providing care as found within large healthcare systems. We take pride in providing direct health services to improve and maintain your health and wellness in a comfortable environment.
Do Nurse Practitioners have to work under or for a physician?
No. Nurse practitioners (NPs) practicing in Indiana are required to do so in collaboration with a physician. Unlike Physician Assistants (PAs), physicians are not required to practice on-site with NPs nor are there any geographic restrictions placed on the distance within which the NP and physician must practice. The purpose of the collaborative agreement is to allow prescriptive privileges for the NP and must outline how the NP and MD/DO will work together, share practice responsibilities, and how coverage will be provided during any absence of the collaborating physician. The collaborative agreement does not constitute a business partnership or employed relationship. The Nurse Practitioner can own and operate an independent health care practice.
Can a Direct Primary Care (DPC) provider treat patients with insurance coverage?
Yes. Patients, who receive health care insurance coverage either through employers or individual insurance plans, can receive primary care in a DPC practice. This is true even if the DPC practice does not participate in any insurance contract. Insured patients can typically receive reimbursement from insurance carriers for care received in a DPC practice via the claims process. The process requires the patient to submit an itemized bill for review and approval by the insurance carrier.
Our office will provide itemized bills at each visit that can be submitted to your insurance carriers. This does not guarantee your claim will be reimbursed.
Do you network with or process insurance?
Why We Do Not Accept Insurance Assignment
Many people who have contacted our office for our services have asked us why we do not bill insurance directly when other medical and chiropractic providers do. We fully understand the financial challenge this presents to some patients, and we wish there were a way for us to bill your insurance company. Unfortunately, at this time, there is not. Here is why:
When clinics bill health insurance companies directly, the providers are required to become participating providers. The providers must sign a contract that allows the insurance company to determine which services they will and will not provide and how much they can charge for those services. In general, insurance companies are not focused on any preventive or wellness services. They are heavily invested in the conventional model of health care that too often relies on drugs and surgery. We are committed to the functional medicine model that addresses the underlying causes of your symptoms with specific nutritional and lifestyle recommendations.
A participating provider must agree to accept the fees the insurance company establishes, regardless of whether the fees are reasonable or applicable to that practice. In general, these established fees cover the actual cost of the briefest (and we believe the lowest quality) care. Providers who are participating providers are required to accept discounted fees for their services, and they cannot bill the patient for the difference between their fee and what the insurance company will pay. Therefore, the clinic must write off the difference, often as much as 50% or more of the doctor’s fee for service. At the same time, the participating provider’s office overhead costs have increased dramatically because of the staff, time, and equipment necessary for processing and tracking claims.
In today’s healthcare environment, the actual cost for providers to provide services continues to rise, while the percentage of reasonable fees that insurance payments cover is declining. At the same time, the profits of health insurance companies and the salaries of their top executives continue to rise to record levels.
Most providers and clinics cope with the requirements of being participating providers by keeping their office visits very brief, so that they can see many patients within a given time frame. When their clinic becomes unprofitable, it must be supported by another institution. Most primary care medical clinics are not self-sustaining financially and have had to merge with hospitals whose expensive, high-tech surgical and diagnostic procedures are priced to keep the clinics afloat financially. Most chiropractic clinics keep office visits very brief and see many people per hour. Ironically, some of our patients complain about their extremely brief and unsatisfactory office visits in other chiropractic and medical practices, while at the same time expressing frustration that we do not accept insurance. Unfortunately, we have found that we cannot be participating providers in the insurance networks and provide the time-intensive, well-researched, expert intensive care that we do.
What about Medicare?
No. We do not participate in Medicare, however; you will be offered discount prices, high quality service and 20-60 minutes of time with your practitioner. Under Medicare law you cannot submit your claims as with commercial insurance companies and you will be asked to sign a waiver to receive services from the practice. This does not forfeit your Medicare benefits for services elsewhere.
Can I use my Healthcare Savings Account (HSA)?
Yes you can. Direct Primary Care is a medical service model and not a health plan under section 223 (c) of the Internal Revenue Code relating to Health Savings Accounts (HSAs). The legislation correctly defines Direct Healthcare services as qualified health expenses under section 213 (d) of the tax code. Please check with your employer for more information.
What can you offer that traditional Healthcare Providers can’t?
Direct Primary Care offers you more time with your provider; more face-to-face time during your appointments, greater accessibility with a larger array of non-face-to-face services such as direct contact with your provider via their cell phone and text-messaging, E-visits via Skype, in-home or place of employment visits. Direct Primary Care ensures primary care services can be accessed in a manner most convenient for patients and their families.
If you are a patient who wants to maintain a direct relationship with your healthcare provider - without the insurance company, government, or employer in the exam room – Langeloh Family Healthcare may be for you.
We are getting back to the basics of personalized healthcare, the way it used to be. The sacred patient-provider relationship is the foundation of high-quality care. Your time is valuable and respected.
We provide the Right service, at the Right place, at the Right time.
At Langeloh Family Healthcare We Listen, We Care.