True North was created to change health care in America. To provide a system that is healthier – for both patients and practitioners – than the present health care system. We have determined that insurance, in its current form, is a barrier to this change. We have therefore decided not to participate with insurers directly. Many True North services are reimbursable through insurance but our different model has prompted many questions. We’ve answered the most common ones here.
> Does True North accept insurance?
> Can I get reimbursed for services?
> Why did True North choose to do it this way?
> But isn’t paying out of pocket too expensive?
> What about Medicaid and Medicare?
> How do I get reimbursed?
> I have an HMO but the physician I prefer to use isn’t covered. What are my options?
> Is there a way to reduce the cost of health-related services not covered by my insurance (e.g. True North services, copays, deductibles, coinsurances, eyeglasses, contacts, etc.)?
> If I can't afford the services at True North, is there another way that I can pay? (links to FAQ page)
Does True North accept insurance?
This question gets at a common misconception. “Accepting” insurance means that a provider directly bills the insurance company on behalf of the patient – in order to do that, the provider must enter into a contract with the insurance company. For a number of reasons (see Why did True North choose to do it this way?) True North providers have chosen not to contract with third-party payers.
Can I get reimbursed for services?
Many of True North’s services are reimbursable by third-party payers. Our practitioners are considered out-of-network providers. If you want to know if your insurance company will cover True North services (and to what extent), call the number on your insurance card and ask what your out-of-network benefits are. Be sure to take notes and write down the name of the person you spoke with and the date of your call.
Why did True North choose to do it this way?
Insurance company’s reimbursement strategies force many contracted practitioners to limit time with patients to between 8-10 minutes. True North practitioners all believe that having enough TIME with patients to hear the whole story is a key part of what creates a relationship between patients and practitioners. Additionally, hearing someone’s whole story sometimes provides the key to unlocking the solution. Without time, trust can’t develop and optimal health is not created. It also takes time to develop a treatment strategy that will work for you as an individual.
But isn’t paying out of pocket too expensive?
When you are used to a sporadic $10-$20 co-pay, paying directly for services can be an adjustment. We encourage all patients to investigate in advance what their deductible and reimbursement rates are. When we last surveyed our clinical patients, we learned that a majority of them received between 60 and 80% reimbursement for services. Our patients tell us the money is worth the value they receive from their care at True North.
What about Medicaid and Medicare?
Medicaid (MaineCare) and Medicare are essentially insurance policies administered by the State and Federal governments to cover care provided by doctors, nurse practitioners, other licensed health professionals, and hospitals to people who cannot obtain coverage in other ways or who are disabled or over 65. The government has strict rules about how providers are paid for services rendered to patients who are enrolled in these programs. Importantly, 1) patients covered by Medicare and Medicaid are NOT eligible for reimbursement for True North services like patients covered by other insurances may be, and 2) practitioners who have active contracts with either Medicare or Medicaid (necessary for when they practice in other places) are not allowed to accept direct payment from Medicare and/or Medicaid patients in ANY facility under any circumstances.
True North practitioners Dr. Semmes, MD, Dr. Simmons, MD, Dr. DeSieyes, MD, Dr. Quinn, DO, Catherine Galida, DO and Dr. Fogg, PhD are contracted providers with Medicare and Medicaid because they see patients in other clinical settings, so they cannot care for Medicare or Medicaid patients at True North at all.
True North clinical practitioners who can see Medicare patients:
Bethany M. Hays, MD
True North clinical practitioners who can see Medicaid patients:
Bethany M. Hays, MD
Kathryn Landon-Malone, RN, PhD(C), CPNP
If you're covered by Medicare and/or Medicaid, you will be asked to sign a waiver stating that you understand that your care with these practitioners will not be covered by Medicare or Medicaid and additionally that you not submit bills to those programs in order to be reimbursed. We know it's complicated and frustrating, but that's the way it currently works.
Medicaid and Medicare patients can see complementary providers and pay for those services out of pocket since these services are not covered by either plan. Please call us if you have additional questions.
How do I get reimbursed?
When you come for your visit, ask the front desk staff if they have the reimbursement forms available for your insurance carrier or download them here. If they do, they will give you a blank form and two copies of your receipt. One receipt is for your records, and the other is for you to send to the insurance company. These receipts contain the billing codes required by the insurance companies. Simply fill out the reimbursement form, attach one receipt to the form, and mail it to your insurance company. Read our "How To" Guide for tips on getting reimbursed.
I have an HMO but the physician I prefer to use isn’t covered. What are my options?
Insurance is expensive, so shop around. HMOs sell many different products and some of these products provide better coverage than others when you go outside the HMO’s own network. Try to purchase a “POS” (point-of-service) or “PPO” (preferred provider network) plan. Both of these typically cover some (usually 50% - 80%) of the cost of a non-HMO Plan doctor. If your employer chooses the products for you, let your company’s management or HR office know that you are interested in plans that offer this greater coverage.
Is there a way to reduce the cost of health-related services not covered by my insurance (e.g. True North services, copays, deductibles, coinsurances, eyeglasses, contacts, etc.)?
Yes, there is. Employers can now offer Medical Savings Accounts (MSAs) to employees, usually at no additional cost to the employer. An MSA enables employees to put aside a portion of their own income, pre-tax, to pay for a large number of health-related services not covered by insurance. This means that the cost of these services to you is basically reduced by the percentage of your income that normally goes toward taxes (and that can be a pretty hefty savings). Even companies as small as 5 or 6 employees can often offer this great benefit at no additional cost. If you don’t have this benefit now, ask your company to make MSAs available to employees.