Frequently Asked Questions
Forum Health Rochester Hills medical providers are not primary care physicians. We don’t provide the acute or routine care services provided by primary care physicians (like pap smears or annual physical exams).
Instead, we act as consultants, advising you on alternative and more natural options to resolve the underlying causes of your health issues. Our goal is to complement the care you receive from your primary care physician, not to replace it. For this reason, we recommend that you maintain your relationship with your primary care physician.
No, we work for you the patient rather than the insurance company. We expect payment at the time of service for services rendered. Service fee is based on the actual time spent with the specialist. Some patients may qualify for insurance reimbursement from their policy if they submit an itemized receipt that we can provide. Our services normally qualify for HSA reimbursement. We do not maintain staff to process insurance claims and requests.
Some of our patients get reimbursement for their visits, but we do not bill insurance companies for our services. We will give you an itemized receipt with the appropriate diagnostic and billing codes on the day of your visit. It will be your responsibility to submit the receipt to your insurance company for reimbursement.
Insurance companies may reimburse patients for a portion of the visit, but it depends on the insurance provider and the individual policy. Often you must meet an office visit “deductible” (sometimes $1000 or more per year) before you can receive reimbursement.
Billing For Lab Testing
Reimbursement for diagnostic testing can be quite complex because it depends on several things.
- “Medical Necessity” - Insurance companies get to decide what they think is “medically necessary”, which usually doesn’t include preventative or proactive tests (looking for early warning signs of problems coming in the future). So, since we are a very proactive medical practice, many of the tests we order may not be considered “medically necessary” by your insurance company and may not be covered.
- “Experimental” - This is another term insurance companies will use when they don’t want to pay for a newer type of testing. Diagnostic testing is advancing at lightning speed, but since the insurance companies don’t want to pay for these new tests, they will deny their usefulness for as long as possible.
- In Network vs. Out of Network - Insurance companies have “contracts” with most traditional labs to keep their costs down. Many of the more progressive diagnostic labs (which we use) are not “in network”.
Since this has happened so many times to our patients in the past, we have developed a work-around that bypasses your insurance company altogether, which could save you thousands of dollars.
Immediately following your initial consultation with one of our healthcare providers, you will be scheduled for your return visit (options include phone, video conference, in-office). A successful outcome from the style of healthcare we provide requires taking steps together to understand the factors contributing to your unique illness and to enable you to use your body’s own amazing ability to heal when it is allowed and assisted to do so. Most of our guests have been ill for a long time and recovery takes time. This type of care often necessitates course adjustments along the way. Any tests that are available at the time of your return visit will be reviewed with you at the time of that visit in order to assist in these care adjustments as appropriate. Since the Medical Board requires licensed provider authorization for many of the tests we recommend and to ensure that you receive accurate education about the nature of the test results, it is our policy to provide you test results at the time they are discussed with you by our providers or their assistants. This is consistent with the policy of most healthcare organizations. We realize that care costs are expensive and we make every effort to provide maximum value and limit costs whenever possible.
A specialist accepts patients from age one year to 100 years of age.
The costs of care are highly variable. We realize that much of the care you receive from us must be paid for out-of-pocket and we are very aware that this care is expensive. The testing and treatment recommendations we make depend on your own personal circumstances of illness. We do not run a “one size fits all” program or protocol for diagnosis or treatment. We try very hard to provide you real value for the services we recommend. Having said all of this, it is typical for guests to incur costs in the first six months of care from us that range from $1,000 to $4,000 to cover provider visits, testing services, in-office treatments, coaching services, supplements and medications. After this time, costs of care are normally much less as your care transitions to a “wellness program.” We will not perform any services that you do not agree to after understanding the reasons that they are recommended. Guests undergoing IV nutrient and other “special” services often exceed the above estimate range.
In order to serve our patients well it is our policy to require four (4) full business days for appointment rescheduling and cancellation (an appointment on Wednesday should reschedule no later than the previous Thursday/Thursday appointment on Friday) to avoid a late cancellation fee of $100. Cancellation fees are not covered by insurance. There is a “no-show” fee of $150. Late cancelation/No-show fees must be paid prior to receiving future services.
Our clinic provides services in a consulting role. This means that we are only available for scheduled appointments during normal office hours. We request that you also have a primary health care provider selected for urgent care and after hour needs. Our office do not maintain an after hours answering service and we do not offer “on call” services.
Our providers recommend a variety of tests to help understand the root cause of your illness and how best to help you recover. Although we do not have a contractual relationship with any medical insurance provider, including medicare and medicaid, some of the tests we request may be reimbursable through your individual healthcare coverage. If this is important to you, please, consult with your payor before services are obtained to find out about coverage. We can provide documentation for you to submit upon your request. We are not staffed to obtain “prior authorization” for tests, treatments and services. Many of the tests and services our providers recommend are, unfortunately, considered to be “not standard” and therefore not reimbursable. Payment for some of the tests we obtain are payable to us at the time that they are ordered and other tests are billed to you by the third party laboratory performing the test. Fees paid to our organization for tests are not refundable. Some tests may be collected in our office while other tests may be submitted directly by you. You may be charged a specimen collecting and handling charge for tests we request. Some test samples are obtained through the third party laboratory performing the test(s).
Feel welcome to contact our office with any questions, we are happy to help you and address your inquiries and concerns.
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Not near our Rochester Hills office?
No problem, our Forum Health Rochester Hills team is available to you no matter where you are.