What About
Insurance?

 Through our direct primary care model, patients can access health care with an easy membership fee.​Because our direct primary care clinic is different from traditional primary care models, we often get questions related to insurance. Here’s a list of frequently asked questions about insurance to help you.

Affordable Health Insurance Asheville NC

Frequently Asked Questions about Insurance:

Do you take insurance?

We do not bill insurance. We can, however, provide our patients with the documentation necessary to submit to the insurance company for out-of-network reimbursement. *Please note that services at Integrative Family Medicine are not billable to Medicare or Medicaid.

Do I need health insurance if I sign up for membership?

We recommend that individuals have some kind of catastrophic coverage, either through a traditional insurance or health cost sharing plan, to protect them in case of a major emergency. Membership covers routine care and helps keep you optimally healthy, but catastrophic coverage is there for unexpected hospital visits, major illnesses, and the like.

What is the benefit of changing our relationship with insurance companies?

Many primary care physicians must see an unsustainable volume of patients per day just to cover their overhead expenses. This results in shorter visits and less comprehensive, less personalized care for patients.. This system all too often means treating symptoms instead of root causes of illness and prescribing medications instead of addressing the whole person. The administrative costs associated with coding, filing, and billing insurance also create a financial burden that affect clinics and patients.

By not billing insurance we can provide longer visits, see fewer patients, keep administrative costs down, and address the roots of your concerns in personal ways that lead to sustainable health.

How does membership benefit me if I already have insurance or a health cost sharing plan?

Members often save money by combining our services with a high deductible insurance or medical cost sharing plan. The high deductible plans serve as “wrap-around” insurance for major events that might require costly procedures or hospitalization. The membership can take care of your everyday health needs, including treating chronic medical conditions, and help optimize your wellness.

Can I seek reimbursement with my insurance company myself?

While we do not file costs through insurance, members may request the itemized invoices needed to submit in-office charges to their insurance provider (excluding Medicare and Medicaid) for out-of-network reimbursement. While insurance companies may have different requirements, most out-of-network claims involve completing a simple form—usually obtainable by searching for “reimbursement form” for your insurance carrier—and providing documentation through an itemized receipt or invoice. We can provide all of the required information so that you may submit your insurance claim yourself.

  • The form for BCBS of NC is here.
  • The form for Coventry One is here.

At the time of your visit, please let us know that you are going to seek reimbursement. This helps us optimize your reimbursement rate. We can make no guarantees concerning rates of reimbursement as they are dependent upon each patient’s insurance provider and plan.

Studies done outside of IFMA such as X-rays, MRIs, and CT scans can be billed directly to insurance through the organization performing the study. You may have copays or deductibles depending on your plan.

How much will I be reimbursed if I submit my own insurance paperwork?

Because our visits are significantly longer, involve health coaching, and are more comprehensive, we find that our patients receive excellent reimbursement. The rate of reimbursement will depend on your plan, the deductible, and level of co-insurance for out-of-network providers.

Can I submit my monthly or yearly Integrative Life Membership fees for insurance reimbursement?

If you pay in full for your membership year at the time of your established care visit or annual visit, we can bill the membership charge as a Comprehensive Annual Visit. Your comprehensive visit is included as one of the benefits of your annual Integrative Life Membership, and this visit type is eligible for insurance reimbursement at an out-of-network rate determined by your insurance provider.

*When paid monthly, membership dues are ineligible for insurance reimbursement since the costs are not associated with specific visits or insurance procedure codes. Furthermore, since establish care/annual visits and other medical visits are included in the membership for a $0 visit cost, when you pay monthly for your membership dues, there is no visit fee which can be reimbursed for those appointments.

By paying for the Integrative Life Membership upfront for the year at your established care or annual visit (Comprehensive Annual Visit) and submitting for reimbursement, you can recover much of the expense of joining. This is the best of both worlds: cost savings and better care.

How much will I be reimbursed?

Because our visits are significantly longer, involve health coaching, and are more comprehensive, we find that our patients receive excellent reimbursement. The rate of reimbursement will depend on your plan, the deductible, and level of co-insurance for out-of-network providers.

Can I submit my monthly or yearly Integrative Life Membership fees for insurance reimbursement?

If you pay in full for your membership year at the time of your establish care visit or annual visit, we can bill the membership charge as a Comprehensive Annual Visit. Your comprehensive visit is included as one of the benefits of your annual Integrative Life Membership, and this visit type is eligible for insurance reimbursement at an out-of-network rate determined by your insurance provider.

When paid monthly, membership dues are ineligible for insurance reimbursement since the costs are not associated with specific visits or insurance procedure codes. Furthermore, since establish care/annual visits and other medical visits are included in the membership for a $0 visit cost, when you pay monthly for your membership dues, there is no visit fee which can be reimbursed for those appointments.

By paying for the Integrative Life Membership upfront for the year at your establish care or annual visit (Comprehensive Annual Visit) and submitting for reimbursement, you can recover much of the expense of joining. This is the best both worlds: cost savings and better care. We will provide all of the documentation for you.

Can I submit my visits or labs to Medicare or Medicaid?

Due to current legal guidelines, our services cannot be submitted to Medicare or Medicaid for reimbursement. We are able to provide an integrative holistic health consultation for these patients; however, this is a non-billable service for Medicare and Medicaid. We do have a number of Medicare patients that choose to see us for the quality of care and length of visit that they receive. All Medicare and Medicaid patients are required to sign an agreement stating that they understand that visits at our clinic are not billable to Medicare/Medicaid.

Lab work for Medicare patients is slightly different: We will only bill Medicare for lab work that is $60 and up per test (panels excluded). Panels are composed of individual tests and therefore not included as billable; only the cost of a qualifying individual test may be submitted. Specialty and hormone testing is excluded; we do not bill Medicare for these labs.

Unanswered insurance questions? Contact a health insurance navigator through the references below:

NC Navigator Consortium: 1-855-733-3711 or ncnavigator.net

Pisgah Legal Services: 828-253-0406 or pisgahlegal.org

The Council on Aging of Buncombe County: 828-277-8288 or coabc.org

Hummingbird Insurance: 828-372-0101 or [email protected]. We recommend Geoff Ferland.

You can also contact a local insurance representative that can meet with you to discuss your situation. These representatives work off of a commission from the insurance company. It will not cost you anything and should not increase your insurance rate.

Insurance representatives will present their organization’s plans. Consider the insurance company that you would like to use, and choose a representative from that organization. Only a few companies are offering ACA plans in North Carolina. To receive the subsidies, you will need to make sure that the representative is signing you up through HealthCare.gov. This will help avoid any confusion and accidentally signing up for a plan lacking the subsidies that you may be eligible to receive.

Are there alternatives to health insurance coverage?

Some patients enjoy medical cost-sharing plan alternatives to expensive and/or high-deductible options through the Health Insurance Marketplace (healthcare.gov). For those whose values align with organizations like Sedera Medical Cost Sharing, pairing a health sharing plan with our membership combines the efficiency of medical cost-sharing with the effectiveness of personalized lifestyle medicine.

Instead of an insurance premium, medical cost sharing plan members make a monthly contribution. In months without eligible medical needs, money paid in is directed to those members who do. Then, when you have an eligible medical expense, funds are directed to your costs.