Subject: Fall updates and insurance changes

Fall Updates from 
Dr. Biemer's office
      October 2018
Happy Fall from Dr. Biemer and Co! 

We have some important information regarding the selection of your 2019 Insurance plan for those that update soon! Please read on.

We understand that some of this can be confusing and as always are here to help you to the best of our ability. We will follow up in a few weeks regarding a new, additional payment option for 2019.

In the mean time get we hope you are all enjoying that Fall sunshine! 

Jim and Julia, and all the staff

INSURANCE ALERT!
Important information for selection of your 2019 and beyond Health Insurance
As of 2019 we are no longer able to accept individual self-pay commercial insurance plans. These are plans that would generally be for individuals under the age of 65 who do not receive insurance benefits from their workplace or are self-employed. This is due to changes occurring in the insurance market place that are beyond our control (Please visit the link below for more info on these changes).
 
We are working on alternative payment solutions for patients who wish to carry on seeing us in spite of coverage. One option we are considering is a direct care payment model. More info on this to follow within a few weeks.

At this time, the changes to insurance do not appear to be widespread among medicare or commercial group plans. However, there are increasing numbers of plans that are EPO and/or Medical Home based plans, which would not support any out of network care. Please see the Quick guide to Insurance Plans below for some advice on which plans we can accept, and don't forget to check networks and benefits when you sign up for any plan.


This is a frustrating situation for our clinic as well as for many of our patients and we are committed to guiding you through it to the best of our abilities. We will do our best to continue gathering information about your options and welcome any insight, feedback, or questions. Please do not hesitate to contact us.
THE TAKE AWAY: We are no longer able to contract with individual insurance plans. Many plans of all types are tightening their networks to medical homes or hospital systems. Check your plan and benefits carefully. 
*Notes on specific insurers* 
  • A number of 2019 Providence Medicare Advantage and commercial plans are now Medical Home models. These plans do not allow you to select Dr. Biemer for primary care, nor do they allow Dr. Biemer to make in network referrals. 
  • Providence has a number of 2019 individual plans. Like other individual plans, these are limited network plans that do not allow you to select Dr. Biemer as a PCP. They are unique in that they also limit Dr. Biemer from making in network referrals. 
  • We are aware of individual networks available through Pacific Source, Healthnet, Moda. Regence BCBS. While we are not in network for these plan, we are not aware of any limitations they would place on our ability to refer you to in-network specialist care. 
What is direct care?
As a result of changes to insurance plans for 2019 (see alert article), we may begin to offer a new Direct Care plan.

Direct care is an alternative to Fee For Service medicine where, instead of billing an insurer for each visit, the patient pays a single annual fee. This annual fee covers all office visits and services available within the clinic. Stay tuned for more information on this option - we will send a follow up newsletter within a few weeks. 
Quick Guide to Insurance Plans for 2019

We have contracts with the following commercial plans...
Aetna, Regence, Healthnet/Centene, Cigna, First Choice, Moda, Pacific Source, Providence*, and United. We can also see patients from certain other plans that offer out of network benefits.**

We have contracts with the following Medicare Advantage plans...
Providence*, United, and Regence. We can also see many other medicare advantage plans such as Moda, Aetna, etc. for out of network costs. These are frequently reasonable and elected by patients.** 

Individual plans from commercial insurers...
As explored in the article above, we are no longer considered in-network for ANY individual plans, nor are there any we are aware of with significant out of network benefits. In most cases* we can still see these patients for out of pocket costs and provide referrals to in network specialists, authorizations etc. We are developing a direct pay option to make available to patients who select this option.
Providence has a strict referral process. For Providence Medical Home plans, Individual plans, and any Medicare Advantage plans where we are not considered in network, we are unable to help our patients see to specialists within their network or to have certain procedures which would require authorization. 
**
Although we contract with the above listed insurers, coverage varies widely by individual plan and network. We ALWAYS recommend that you check with your insurer to determine whether our clinic is in network and if it is not, to learn more about out of network benefits. We are happy to work with you when trying to determine coverage. 


James Biemer, 9135 SW Barnes Rd, Suite 863, Portland, OR 97225, United States
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