February 2025
Gary Scheiner MS, CDCES
Owner, Clinical Director
To Bill, or Not to Bill
It’s a question we receive every day.“Does your practice bill insurance?”Seems like a simple yes/no question. But before I reveal the answer, I want to share a few facts. When it comes to healthcare expenses, I get it. Health insurance isn’t cheap, and we should use it as much as possible to help offset the cost. Many health insurance plans cover diabetes self-management education (DSME) services, so it makes sense that we would bill insurance for our services. But there are some important considerations. For starters, every health insurance plan has its own rules & regulations regarding who can provide care, how often, where, and to which individuals. They also have their own unique referral, billing and payment processes that must be adhered to carefully. If there were a handful of health insurers that covered most of our patients, we could figure all that out. But our practice serves people in all 50 US States and more than 40 foreign countries. That involves hundreds, if not thousands, of health insurance plans. We would need to hire a full-time staff just to handle the paperwork, and that would send our overhead expenses (and cost of services) through the roof. Billing health insurance, whether it be a private plan like Blue Cross/Blue Shield, or a public plan like Medicare, comes with lots and lots of restrictions. Being “in-network” with these plans means that we must charge everyone the same amount (and collect deductibles) for a narrow menu of services. No more customized programs for things like insulin pump use, weight loss and pregnancy. No more “retainer” packages that include all-important coaching and fine-tuning between appointments. And no flexibility when it comes to appointment frequency. Plus, most health insurance plans simply don’t pay practices like ours enough to stay in business. Rather than being able to spend time with each client, we would have to churn out appointments every ten minutes. Otherwise, the only way to pay the bills is to group 10-20 people together in a class format. This makes it nearly impossible to individualize treatment and focus on each person’s specific goals. And given that health insurance companies are large, complex bureaucracies, you can imagine how long it takes to get paid – something that absolutely kills cashflow. So clearly, the answer is no. We don’t bill insurance. But I think we offer something better: FLEXIBILITY. Anyone who cannot afford our usual fees is welcome to pay whatever they can afford. We have not and will never turn anyone away due to an inability to pay. That doesn’t mean that everyone should be asking for a discount. We feel that our services bring tremendous value, so we try to limit substantial price breaks to those who truly need them. And for those who do pay (any amount), we provide billing statements that include all the necessary details for submission to health insurance. In many cases, our services can be applied to “out of network” benefits and are eligible for some reimbursement. If anyone has questions about our billing policies, please reach out to our friendly office manager, Nancy Siegel. She is more than happy to help in any way she can. Remember, even though we still have to make ends meet, we’re here to help people first and foremost. I hope you enjoy this month’s edition of Diabetes Bites, featuring columns from our nutrition and weight management specialists. If you haven’t played our trivia game or taken our monthly survey before, be sure to check them out towards the bottom. As always, please reach out if there is anything we can do to assist you in reaching your personal diabetes goals. Call 610-642-6055 or send an email to info@integrateddiabetes.com. When you call, be sure to ask if we bill insurance. It drives our front desk crazy.
Gary Scheiner MS, CDCES
Owner, Clinical Director
