Insurance Questions and Suggestions
What if I have traditional insurance or an HMO can I still benefit from SimpleCare?
Will my insurance accept SimpleCare receipts?
How do Medicare and SimpleCare work together?
High-deductible policies and MSA's
Link to Insurance Agent/Broker Providers
For Employeers
Why should I offer SimpleCare to my employees?
Offering SimpleCare as an added benefit to your own, and your employees healthcare benefits, will save you and your staff money regarding most healthcare expenses. Most people never satisfy todays high insurance deductibles, resulting in them paying the full, over inflated insurance price for routine healthcare services.
Be the hero, pay for or recommend a SimpleCare/AAPP annual membership of only $29 to $39. It’s a small price to pay for the respect you’ll gain from your employees. And, it’s a write off!
For Business's and Insurance Agents
What if I have traditional insurance or an HMO can I still benefit from SimpleCare?
Yes, SimpleCare patient members benefit by paying a lower price for their SimpleCare provider's services, when they pay in full at the time of service. (PIFITOS). They also gain the freedom of seeing the providers of their choice, not someone from a limited list of "Insurance In-Network" providers.
SimpleCare can also benefit you if you are seeking medical services, alternative care or health care providers not "allowed" by your insurance carrier. When you see a SimpleCare provider, the quality of care and type of treatment you receive is decided upon by you and your health care practitioner, NOT your insurance company.
Your insurance carrier may or may not reimburse you for seeking care from "non-participating providers" or for services disallowed within your policy. For more specific answers regarding your health insurance policy, or reimbursements, you should discuss your "Out of Network Benefits" with your insurance company member services and/or your insurance broker/advisor.
Will my insurance accept SimpleCare receipts?
Most will not, but some will. Check with your insurance company or broker/agents if you are considering submitting SimpleCare codes for reimbursement or to apply towards your deductible. We suggest you track health care expenses that may qualify for tax deductions. Your tax advisor will be able to guide you with such information.
SimpleCare does not use the insurance industry - CPT codes. SimpleCare health care providers can afford to lower their fees for you because they do not incur the high costs associated with insurance coding and billing. Insurance codes usually are represented by a higher price than SimpleCare's time and materials-based codes, so by requesting the higher-priced codes you are requesting a higher price for the visit. If your high deductible policy or health savings account requires coding, you may or may not be able to use SimpleCare for that visit. However, you might not need to submit each and every form to your insurance company if you do not exceed your deductible. We recommend that patients use SimpleCare for routine health care costs and then only submit claims toward their deductible for larger items. Also, be aware of any contractual obligations that might require your provider to bill your insurance company before collecting from you.
How do Medicare and SimpleCare work together?
Medicare does not allow a "Medicare provider" to charge a "Medicare patient" a cash price without billing Medicare first. However, Medicare patients can see any non-Medicare provider they want and receive the SimpleCare price, as long as the service is NOT submitted to Medicare. Considering that many doctors are opting out of Medicare due to excessive administrative demands and cost, SimpleCare may be an ideal solution for patients seeking medical services, alternative treatments, or providers that are not participating with Medicare. SimpleCare may be a sensible alternative for Medicare patients who prefer to see non-Medicare providers or who do not choose Medicare Part B.
If you seek medical services or providers that are not covered by Medicare, then you can ask any licensed health care provider to join SimpleCare and you will receive their best price when you pay in full by cash, check, or credit card at the time of your visit.
SimpleCare, Insurance and HSA's Analagy
The SimpleCare approach is very simple and is used every day by us with our car insurance. For example, with car insurance, you pay for the routine maintenance (gas, oil-changes, wiper blades, tune-ups, etc.) and insurance pays only if there is a major accident. You do not "bill" the insurance company for each and every gas receipt, wiper blade or new tire but only when you have a major accident or event that would require your insurance company' involvement. It would not only be very expensive and cumbersome to expect the car insurance to cover a portion of your weekly gas expenses it is not what insurance is designed to do. True insurance covers unexpected catastrophic events, that do not usually occur. SimpleCare is simpler, less expensive, and provides more freedom to choose the doctors and type of health care you desire.
You also may wish to include a Health Savings Account (HSA). This allows you to control the money you spend on health care, helping those pre-tax dollars go farther.
Resources for Health Savings Accounts
The following companies and insurance brokers/agents are provided for informational
purposes only. You may contact these or other insurers or your state Insurance Commissioner's
Office for additional information on high-deductible catastrophic insurance and
HSA's.
HSA Bank
Offers HSA's nationwide, including an HSA debit card program.
www.hsabank.com
Patient centered and cash-based healthcare Resources
Association of American Physicians and Surgeons, Inc. – AAPS
A voice for private physicians since 1943 promoting freedom in medicine.
www.aapsonline.org
Americans for Free Choice in Medicine
AFCM promotes the philosophy of individual rights, personal responsibility and free market economics in the health care industry.
www.afcm.org
The Galen Institute
An innovative research organization focused on health and tax policy - advocates for affordable health care solutions and consumer driven health plans.
www.galen.org
Liberty Health Group
http://www.libertyhealthgroup.com/
The True Cost of Healthcare
David Belk MD shares the truth about insurance companies and the games they play with our money.
www.truecostofhealthcare.org