68. Why We Don’t Bill Insurance and How It Benefits You

In this episode of Cycle Wisdom, Dr. Monica Minjeur delves into the unique benefits of a cash-based, direct specialty care model. She shares the heartfelt story of Carol, a patient who found clarity and hope after years of frustration within the traditional insurance-driven healthcare system. Dr. Minjeur highlights how bypassing insurance allows for individualized, transparent, and holistic care that prioritizes long-term health and fertility. If you’ve ever wondered why Radiant Clinics operates outside the insurance model—or how this approach could benefit you—this episode is packed with insights you won’t want to miss!

Transcript

Monica: 0:02

Welcome back to Cycle Wisdom, where we empower women to restore natural menstrual cycles to improve health and promote fertility. I'm your host, Dr. Monica Minjeur, and I'm so glad you're listening today. On today's episode, I'm answering one of our most frequently asked questions. Why doesn't your practice bill insurance? So we're going to start off today, as always, with a patient story about Carol. Now Carol was struggling with infertility for about two years before she brought it up at her regular wellness visit through her primary care office. Her doctor and she discussed it for about five minutes. The doctor ordered four lab tests and she was told with these results that everything was normal and they should just keep on trying. When Carol got the bill from her doctor's office for this five minute exam, as well as the lab tests that were ordered, she found that she had been billed an office visit of 175, which did get billed to her insurance. And of that, she ended up paying a 20 copay. She didn't have any answers, though, and she continued to struggle for the next year to get answers or to get pregnant. Luckily for her, though, a friend referred her on to our clinic for additional evaluation. Now, prior to having that first visit, I had a conversation through a discovery call with her where we discussed our pricing structure. I detailed that it was pre set pricing and it would be all inclusive of the things that she would need in order to achieve her goals. Over the course of the next couple of months working with us, what she experienced were 60 minute appointments with charting instructors, as well as a 60 minute medical visits with me. Within three months of working together, we had been able to have as many visits as we needed during that time window, and we were able to come up with multiple different diagnoses that were the underlying root cause of her fertility troubles. We also were able to start on a treatment course and had a very clear picture of her fertile window and the next steps. necessary in order for her to try and get pregnant at a follow up visit. She said to me, I feel so seen and heard, and I no longer feel like just a number in the healthcare system. We are so much further ahead in figuring out how to conceive. And now I have a plan forward that actually gives me hope. I don't spend any time worrying about the hoops I would have had to jump through for insurance to get anywhere near this level of evaluation and clarity to my treatment course. Carol's story is so common, and we see this often that people are very frustrated working within the confines of the conventional healthcare system. And it's not to say that the doctors are bad or the healthcare teams are bad, because they are exceptional human beings. But unfortunately, oftentimes the underlying cause here is the insurance companies that are trying to dictate It's What is happening? So I want to give some guidelines here as far as kind of why cash based model is very different and how it allows us to really help provide you the care that you need and deserve. So one of the first reasons we talk about is that it gives us the freedom to provide what's truly individualized care. So, many people know or suspect that insurance often will dictate treatment protocols, which can limit the time that a physician will spend with you, as well as the type of care that can be offered. So, for example, if you come in and you have a diagnosis of menstrual migraines, or maybe you have irregular cycles, insurance will say, oh, you have these irregularities, therefore you should go on oral contraceptives. In general, they recommend that that visit should be about a 10 to 12 minute visit, sometimes less depending upon the healthcare system you're working on. On the flip side of things, in a cash based practice, I can focus entirely on you and your unique needs, as well as take the time to address the root causes of your health issues, rather than trying to meet some insurance imposed requirements. This means I get to spend as much time as I need to to understand your concerns, develop a customized treatment plan, and provide holistic solutions to prioritize long term outcomes rather than just a quick fix. The second reason that I love working in the model that we do is that we're able to have a direct relationship with the patient. So I've been able to remove insurance companies from this equation, meaning I can work directly with you without that third party interference. For This helps to ensure that every decision we make about your care is based on your best interests, not just what an insurance company thinks is necessary or what is a covered benefit. This allows for us to have a more transparent relationship where our focus is entirely on your health, not on meeting administrative requirements of particular charting documentation, of particular medications that we need to try in a certain order, or of what therapies, treatments, or additional workup should be done. Now, this is not without saying that I still do follow evidence based guidelines. I still do document every single office visit in my notes. Everything is there that needs to be there, but it allows us to be able to work in this pattern that says, Hey, we are working on what is best for you without having to say, what is the insurance company requiring in order to make sure that this claim is being paid out? Another reason that I love to work in this model is that it allows me to spend more time with you. more attention to your particular details, and that allows us to have better outcomes. Oftentimes, insurance based practices require doctors to see a higher volume of patients in order to remain financially viable. This oftentimes will mean that you have appointments that are much more rushed. I have seen patients in the past who say that their doctors literally have a five minute appointment with them. Now, typically, the standard is somewhere closer to 10 to 15 minutes, but But even with that, it's an incredibly rushed appointment, and it makes it really challenging to get your points across, as well as come up with a clear treatment plan going forward. With a cash based model, I can take the time needed to thoroughly evaluate your concerns, as well as provide education and support. and in depth care. Some appointments are 30 minutes, but most of the appointments through our clinic are 60 minutes, especially in the beginning when we're digging deeper to determine appropriate diagnosis and treatment plans, when we're providing any sort of education on how to chart your cycles, as well as hormone coaching and health coaching. All of these are going to be a full 60 minutes that we spend with you. Now, it goes without saying that when we're able to spend more time with you, we're able to address your concerns, we're able to provide that quality education that you need, and this leads to better outcomes because we can focus on finding and treating the root cause of your health issues rather than just simply managing the symptoms. Another important piece about our practice is that it's incredibly important to me that we are very transparent in our costs. If you're working with an insurance based model, patients oftentimes have hidden costs. They maybe don't even have a clue as to what their insurance is getting billed, and they don't necessarily always know how much is going to be their out of pocket cost, or what's going to be denied as a claim from your insurance. With the model that we utilize, we have full transparency, so you know exactly what you're paying for up front. Additionally, by avoiding working with the insurance companies, we're able to keep our costs lower overall, and eliminate that unnecessary overhead, because we're allowed to focus instead on delivering value driven care. We also utilize package based pricing within our clinic, and it allows us to include everything you need within a certain area of treatment. So, for example, if I'm seeing you for medical services, you will know that this is the particular price that you're paying either monthly or up front. If you're being seen for hormone coaching or charting instruction, that pricing is transparent from the start. There's no hidden fees, there's no add ons, unless we have that discussion and explain, this is why I think we need to add in an additional piece of this. Now, there are lots of ways in order to try and recoup some of the money that you're paying out of pocket. And one of the things we always encourage is for people to check with your insurance company if you are under medical coverage to see if you have any out of network reimbursement. If that's the case, you're able to ask for a super bill and an invoice to submit back to your insurance to let them know, Hey, I paid this out of pocket. Even if you don't get any money back, this can sometimes be applied towards your out of pocket maximum for the year, which for some people does make a big difference. You're also not necessarily needing to use just cash. We don't expect people to hand us 20 bills when they come into the office. You are able to use other options like credit cards, like bank accounts, like an HSA, which is a health savings account, or a flex spending account. And again, because you know transparently what that monthly cost is going to be, you can set aside money on a monthly basis in order to be able to cover those costs. Finally, if you don't have any coverage, if you don't have any HSA, or if your insurance doesn't reimburse you for anything, we still always recommend that you keep any of your medical bills and invoices to submit to your accountant for when you have your taxes done. In some cases, you may be eligible to use this as a medical expense that you've paid out of pocket for the year. Now the final point I'd like to make is that when we are not utilizing insurance in order to provide care for you, it allows us to. Promote a more natural and holistic approach to health. So in our world where we're working with deep diving as far as menstrual cycle evaluations, learning fertility awareness methods, and the treatment through root cause care, hormone therapy, we're often finding that these methods would not be covered by insurance because they don't fit conventional medicine's standardized approach at this point in time. Now we are starting to see that some insurance companies are covering additional fertility services. It's not clear yet as to if those will be covered as far as the realm that we're working in yet, but at this point in time insurance typically does not cover this deep dive into getting to the root cause of your health problems. The cash based model, on the other hand, gives us the flexibility to focus on prevention, focus on natural treatments, evidence based approaches, and it allows me to recommend things and give significant education on modifying your lifestyle, on supplements or food choices that are going to help promote longer term health, rather than just treating your symptoms or providing a quick fix, because ultimately, we're looking at promoting your long term health. Not just getting rid of a pesky symptom, not just covering it up with a band aid approach. Imagine what it would look like if you walked into a doctor's office knowing exactly what you're paying for and why. Imagine walking out of that office with a treatment plan that's tailored specifically to your needs, not a cookie cutter solution dictated by an insurance company, to improve your health and promote fertility. This way forward is possible by working with our elite team of healthcare professionals. Go to our website, radiantclinic. com, to schedule a free discovery call with me and learn more about our package based pricing for comprehensive care. We are currently able to see people for in person appointments in our Cedar Rapids, Iowa clinic, or can arrange for a telehealth visit if you live in the states of Iowa, Illinois, or Minnesota. More to come soon. Thank you so much for listening to this episode. Please share this podcast with someone in your life who would benefit from our services. Remember to subscribe to this podcast for more empowering content that I look forward to sharing with you on our next episode of Cycle Wisdom.