Optimized Wellness Center believes in the value of holistic care and functional medicine for you and your family. Our goal is to help you achieve the best possible outcome and we understand that exorbitant prices can be an obstacle to healthcare for many. Therefore, we have created a pricing structure that can be tailored to you.
Unfortunately, most insurance plans do not adequately cover the services we provide to get you feeling your best. For instance, typical insurers cover only the most basic and palliative chiropractic care. We believe our multidisciplinary functional medicine approach which includes comprehensive neurologic and balance assessments, soft tissue work, manual therapies, functional labs, rehabilitation exercises, detoxification therapies, cold laser, body contouring, customized nutrition plans, nutrient injections, etc. will make a significant difference in healing your body.
The good news is that we can issue you what is called a Superbill which contains the billing codes for services rendered, giving your insurance provider all the information they need to maximize direct reimbursement to you. Our status as out of network with all insurance providers saves you money in the long run since it allows us to keep our costs low and offer you discounted payment plans up front.
What Forms of Payment May I Use?
We accept cash, all major credit cards, checks and pre-tax dollars from Flexible Spending Accounts (FSA) and Health Savings Accounts (HAS). In addition, you can take advantage of our affordable payment plan options to make the cost of care manageable for you and your family. Optimized Wellness Center wants to help you care for your most important asset – your health. We strongly believe that functional medicine including comprehensive care can help you address your current health concerns and prevent future problems. Overall, this approach will be far less expensive than traditional medicine as it seeks to treat the root cause of illness with real pain resolution and improve functional outcomes rather than with more pain medications or invasive surgery. If you are ready to take control of your health, call us today at 510-497-4424!
Will my medical insurance reimburse me for my consultation & labs at Optimized Wellness Center?
We are unable to confirm nor deny whether or not your insurance company will reimburse charges for the visit. We do not accept any form of medical insurance for consultations. If you are attempting to use insurance benefits, orders by a functional medicine or chiropractic doctor may be included or excluded from your coverage depending on your insurer and your plan. We cannot guarantee they will cover any or all of the costs. In our experience, some insurance companies request additional information that is very detailed and resource intensive. At this time, Optimized Wellness Center does not have the ability to assist with insurance reimbursement above and beyond providing you with the diagnosis codes, tests codes, and consultation receipt for the consultation. Our office is not legally allowed to contact your insurance company regarding your benefits. We recommend that you call your insurance provider to determine eligibility for coverage of any services or studies requested. We will do our best to provide you all the information necessary.
Helpful Tips When Communicating With Insurers.
You may find it helpful to record the name of the insurance representative you speak with and the date of your call, in the case of any later dispute. Once studies have been ordered through insurance, if your coverage is denied you will be responsible for the billed amount at the insurance rate. The following questions may be helpful in determining coverage when calling the number on your insurance card listed for customer service or benefits:
● Are services provided by a functional medicine or chiropractic doctor in the state of California covered by my insurance?
● Are routine and diagnostic laboratory studies ordered by a functional medicine or chiropractic doctor in the state of California covered by my insurance?
● Are imaging or other diagnostic methods (X-Ray, ultrasound, CT scan, MRI, etc.) ordered by a licensed chiropractic doctor in the state of California covered by my insurance?
○ If yes, do they need to be ordered at any specific lab (usually Labcorp or Quest) or imaging facility?
● Are there any limitations or exclusions?
● Do any of these services or evaluations need to be ordered only by my designated primary care doctor?
● Do I need to meet any deductible before coverage applies?
● Will I be responsible for any co-pay or portion of cost not covered?
What If I Don’t Have Insurance?
If you do not have insurance coverage for conventional laboratory studies recommended by your functional medicine or chiropractic doctor you may have the option to run your laboratory studies through a company called Professional Co-op or Ulta Labs that does not participate in insurance billing and therefore offers significant discounts for payment at time of service. Our office collects payment for these labs at the time of providing you with your laboratory requisition (order). This often makes the same labs available at a fraction of the insurance pricing structure. You may be able to submit your payment to your insurance company, a flex spending account (FSA) or a health savings account (HSA) for reimbursement, if applicable. Additionally, you may be able to order your own labs at “cash” pricing through a company such as Direct Labs.
Can OWC Contact My Insurer and Do This For Me?
At this time, functional medicine doctors in the state of California are not able to contract with any insurance companies as providers. Therefore, we do not provide any direct billing to your insurance company and all fees are due at time of service. Our office can provide you with a coded service summary (Superbill) that you can submit to maximize your insurance reimbursement or to health savings accounts (HSA) or flex spending account (FSA). A minimum of $20 will be charged for providing duplicate service summaries after the date of service. Any contact received by our office from your insurance company for information already provided on the service summary will not receive a response from our office. If there are questions about why a submitted claim is denied you will need to speak with your insurance company about what additional information is required, and we will be happy to provide you what we can. Unfortunately, our office is unable to call your insurance on your behalf. There is currently no coverage in California for MediCal or Medicare with functional medicine doctors.
Will I Need To Perform Various Labs? Licensed chiropractic and functional medicine doctors in the state of California are able to order any laboratory studies, imaging and most diagnostics related to your care. We may recommend various forms of evaluation including x-rays, blood spot, blood draw (serum), urine, stool, salivary or breath test. We work with both local laboratory and imaging centers and also use some evaluation methods that provide you with a kit for home collection from our office. We may recommend both conventional and functional studies so that we can better assess what’s going on and provide you with the most specific recommendations. Lab results review is only conducted at follow up appointments, the only exception is if we need to contact you due to urgent results. This is because of our responsibility as a healthcare provider to review the results with you. If you need results for any evaluation ordered by our office for consult with another practitioner or specialist, please provide us with a signed records release two weeks prior to the time you will need your results so we can prepare accordingly.
What Is The Cost Of Labs? For any lab or evaluation that we collect payment for, we provide you with our cost without any markup, as is legally required. To offset the cost of managing supplies, orders, results, test kits and payment with credit card, we charge a lab handling and analysis fee to cover the costs of offering testing through our office. Depending on a practice member’s individual needs, the lab costs can be expected to run between $250-$1500. Will OWC Coordinate With My Other Doctors? Our doctors are happy to coordinate care with your primary care doctor or other specialists you are working with in order to help you benefit from any insurance coverage you may have. We will provide you with a form letter with a list of any studies recommended by our office that you would like to request of another provider. Beyond this standardized form, any letters or communication required by your doctors to assist you in coverage may be billed at our standard service rate as covered in our office policies form.
How much should I expect to invest on lab testing at my first visit? Testing is something that will be discussed in detail at your initial appointment with recommendations made on a case by case basis. If lab testing is deemed necessary for your case, it will typically result in the most in-depth comprehensive laboratory analysis consisting of both conventional and functional lab testing. This helps us be more precise with the care we provide. With the conventional labs that are ordered, you can bill your insurance directly, or you can pay the discounted cash rate we have negotiated with Quest and other labs (at our cost without any markup). If you pay the discounted cash price for these labs, you will still receive an invoice (Superbill) with CPT codes to submit to your insurance in an attempt to get reimbursed. Please be aware that some of the labs we order are considered “experimental” by insurance companies. If insurance does not cover the labs ordered, the rate the lab companies will bill insurance will likely be significantly higher than the discounted cash rates. Specialized functional laboratory testing through Brain Span, Cyrex, Doctor’s Data, DUTCH, Igenex, Genova, Great Plains, Meridian Valley, Spectracell, ZRT and other functional lab companies may also be ordered at the initial visit. Some of these tests are billable through insurance, while others are cash pay. To offset the cost of managing supplies, orders, results, test kits and payment with credit card, we charge a lab handling and analysis fee to cover the costs of offering testing through our office. Most patients invest an average of $300-$1500 in laboratory testing at their new patient visit.
Please let us know if we can answer any other questions.