After long and careful consideration, we have made the decision to no longer take any insurance, including Medicare, starting January 1, 2022. We also will not be requesting or accepting single case agreements. We deeply regret the negative impact this will have on you.
The current health care model in the United States simply does not provide appropriate reimbursement given the amount of time and level of care that we provide for our patients with chronic complex illnesses. Therefore, we will be adopting new procedures similar to other practices throughout the country that care for complex patients.
We understand this will have a significant impact on current patients. We realize that for many of you we have been providing much-needed care not readily available from providers elsewhere. We also appreciate that not having services covered by insurance is difficult from a financial standpoint. Again, we are sorry to have to go in this direction, but current insurance reimbursement practices do not provide a sustainable path for the Center to continue to offer such time-intensive services.
For our current patients, we have attempted to provide cost-effective options for care from our Physician Assistants and Dr. Saperstein. If you have out-of-network benefits with your commercial (non-Medicaid/non-Medicare/non-Medicare Advantage*) insurance, you may be able to get some part of your cost reimbursed to you by your insurance. To facilitate this, we will provide superbill and a link to an app called Reimbursify to help you submit the invoice to your insurance.
If you have Medicaid or AHCCCS, the 20th Century Cures act does not allow us to provide you with any orders, prescriptions, or diagnostic testing referrals. You can still pay to see us, but you will need to have a physician who is a Medicaid/AHCCCS provider to place any orders.
To ease your financial burden:
We know that with chronic illness there are often tests that need to be repeated or new tests required. To facilitate this, we will be collaborating with HealthPoint Neurodiagnostics to provide key diagnostic tests, such as autonomic testing, EMG, and EEG. Dr. Saperstein will make sure the tests are performed and interpreted to his standards and you will be able to use your insurance benefits (including Medicare and Medicare Advantage plans). HealthPoint Neurodiagnostics will bill your insurance directly for diagnostic testing.
To minimize your out-of-pocket costs and keep working with us, you may choose to seek other specialists for some of your issues – for example, a headache specialist for your migraines or a GI specialist for your gastric issues. While we are willing to continue to manage such issues, these additional parts of your care will require more time with our providers and will therefore cost more out of pocket.
If you have had an appointment with Dr. Saperstein or one of our Physician Assistants, in-office or via telehealth, in the last 6 months, we can continue to provide refills for your non-controlled prescriptions at no cost to you until June 30, 2022. However, if there are problems or you require significant changes to your medications, an appointment would be necessary. Some medications require visits more frequently than others, so we may not be able to provide that prescription without a visit. As current patients, we will offer you the same rates as this year for those appointments. For long-established patients, the cost for a follow-up will remain the same for a visit with a Physician Assistant. As always, they will continue to work closely with Dr. Saperstein and will consult with him as needed. If you choose to see Dr. Saperstein instead, that will be at his hourly rate.
We encourage you to have a primary care provider or another provider who is in your insurance network and willing to work with you. We would be happy to work with them to facilitate their providing orders for your treatments.
We have had to update our Financial and Appointment Policy. We need you to sign this and our new treatment agreement via Klara at least one week prior to your first appointment in 2022.
We look forward to continuing to provide you with excellent care. If there are any questions, please do not hesitate to reach out to us via Klara or phone.
David Saperstein, MD
*If you are a Medicare or Medicaid beneficiary, or you become one, we are required to have you sign a private care contract, as dictated by Centers for Medicare and Medicaid, before we can provide any treatment or consultation. As Complex Neurology, LLC is Opting Out of Medicare effective January 1, 2022, you will not be able to receive reimbursement for services we directly provide.