More Information About the New Clinic Model
I am writing to provide some more information about the new clinic model that will go into effect on March 15th, 2022.
First, I want to talk about why I believe the membership model is a more effective way to provide healthcare.
The membership model includes one-on-one visits as we do now and also includes group sessions. Group conversations allow for people to hear other people’s questions as well as their shared experiences. When I have led workshops in the past, I have been amazed by the power of people coming together, learning that they are not alone and then engaging in a positive process that leads to sustained health. Even when people choose to listen and not directly participate in group health processes, they benefit from hearing the answers to questions that they might not have thought to ask and they have the opportunity to hear a more in-depth discussion of their condition than time allows in a normal office visit. Group conversations remind people that they are not alone and also allow for each person to get more information about their condition and treatment options.
In the current system, dealing with health issues is often a lonely process. The way that I and other providers practice medicine involves a doctor and a patient in a room. The patient is the person with the problem and the doctor is the fixer of problems. I strive to make that interaction more like two people sitting down at a table where one (me) knows more about diagnosis and treatment and the other one (you) knows more about how their own individual body works. Even with that intention, the design of fee-for-service care makes it inappropriate for me to tell you about my personal experience or to step out of the role of the problem solver. I have said (and thought about saying) to many people “I wish you could be a fly on the wall in my office for a day so you could see how many people come in here and say the exact same thing and also think they are the only one.” People are surprised to hear that others have the same experiences and challenges around health.
Membership is not just about having a flat fee for visits and access to workshops. It’s about creating community around health. It’s about building a community that supports each person in learning how to care for their particular body. Understanding our body’s needs and how to address them helps us to navigate around or through disease and towards wellbeing. This is a constant process for each of us. Health is not attained from a twelve week diet or a two week cleanse, it is a process of finding what works for us and then adjusting that based on age, circumstances and seasons. By joining together, we get to learn from each other and I, as a doctor in this community, get to share more than just information about fixing health problems. I will get to share more foundational information about health. My dream is to create a space where people get to learn about themselves and be supported by community as they find and maintain the ways of living that support them in truly feeling well. I have witnessed so many times that health begins the moment someone embraces themselves as the complex human being that they are and engages in the care of their body from that place.
Some people have been concerned that I will not have enough time to care for patients if I am preparing for and presenting seminars and workshops. I am keeping the same schedule for visits and I expect that I will have more than enough time to prepare and present workshops as soon as I do not have to spend time fighting with insurance companies. I have been spending 10-20 hours per month dealing with insurance billing issues over the past seven months (on top of all of the hours my billers spend submitting and resubmitting claims). I also spend at least 5 hours per month procrastinating this part of my job because it’s the part of my job that is frustrating and draining. Beginning in March, I will get to dedicate that 15-25 hours per month to preparing and presenting workshops and seminars and connecting with guest presenters.
In the new system, the cash pay price is an option so that people who want to submit to insurance for reimbursement can do so. Some clinics that move to a direct primary care model do not have this option. I chose to keep it to accommodate people who want to submit to insurance or who generally see me for an annual visit. The per-visit fees include prep time, lab review, referrals and case research outside of the visit.
If you prefer to see an in-network provider, I understand completely and I support you in making the decision that is right for you. I highly recommend Dr. Kathleen Cannon, ND (www.drkathleencannon.com) and Anna Licciardo, ND (www.ctvitality.com). I do regular case review with these two fantastic doctors and I trust them to provide excellent care.
With these changes in place, I will have more time to be a better doctor and serve this community. Working with insurance companies has been a challenge throughout my time practicing medicine. This downcoding situation over the last six months has been so demoralizing that it has made me question why I practice medicine. The new clinic model gives me the dignity of not having to fight to get paid for the work that I do. Separating myself from the insurance system allows me the time to do the work that I love and provide better care for anyone who is willing to take this next step with me.
If you have any questions, see the frequently asked questions below. Please reach out with any further questions to the membership coordinator, Matt at membership@drgwennrosenberg.com or to me at clinic@drgwennrosenberg.com
If you want to sign up for membership, please email membership@drgwennrosenberg.com
Thank you,
Dr. Gwenn
FAQs
Membership
Is this concierge medicine?
No. Concierge medicine generally involves a yearly fee of $3000-$5000 and then visits are still submitted to insurance for reimbursement. Direct Primary Care is not concierge medicine because individual visits are included in the membership fee along with group sessions and workshops. This model was used by most primary care doctors (without the group sessions and workshops) before for-profit health insurance took over.
Does membership include visits?
Yes, the membership fee includes medically necessary visits with Dr. Rosenberg, up to 3 personal email questions per month, same-day scheduled callbacks for urgent matters and routine callbacks scheduled within 2 days. Visits will be scheduled in the same way that they are scheduled now and will be 30 minutes for regular follow ups and 60 minutes for more complex follow ups.
Can I use my Health Savings Account (HSA) to pay for membership fees?
Membership fees are Health Savings Account (HSA) eligible.
How will I pay for membership?
You will receive a link to set up automatic monthly payments which will begin on March 15th and be deducted on the 15th of each month.
Will there be an annual contract for membership?
Membership is month to month and you can cancel at any time.
Can I pay for the full year in advance?
Yes, you can. Contact membership@drgwennrosenberg.com if you prefer to pay for the year up front.
Is financial assistance available?
It is very important to us that no one be unable to joint this community for lack of funds. Please email membership@drgwennrosenberg.com to discuss options which include income-based scholarships and work-trade.
What if I need help using the online platform?
If you have trouble using video platforms, please contact membership@drgwennrosenberg.com. Matt, the membership coordinator, has worked in a college IT department and he is a kind and patient teacher. I am hopeful that someday soon we will be able to gather in person for some of the workshops and events.
Does being in a workshop mean that I will have to talk/share?
No. This whole program is being put together by me and I am an introvert. I will never pressure anyone to say or do anything in a group setting. You are welcome to keep your camera off and message or email questions (even afterwards).
Insurance/ Fee for Service
Can I use my insurance?
I will not be in network with insurances so non-members will pay me at the time of service and I will give them a superbill and receipt to submit to insurance for reimbursement. Some insurance policies have a separate deductible for out of network services.
I am used to getting a cash pay discount or a sliding scale discount for visits. Does that still apply?
The membership option gives us the flexibility to provide financial support but the office visit fee does not have this flexibility. Please contact membership@drgwennrosenberg.com and Matt will call you about financial support.
I want to pay for visits and have them reimbursed by insurance. Is there a way to still get access to workshops and seminars?
If you are paying for visits and want to have access to workshops and seminars, you can pay a monthly fee of $62 to have access to all workshops and seminars. This membership will be available to anyone who has established care with me, even if they choose to see another doctor for regular visits moving forward. As of right now, I am not offering membership to people who are not current patients. If someone you know is interested in becoming a workshop and seminar only member but is not a current patient they can email membership@drgwennrosenberg.com and we will contact them once we get a sense of whether we will have room for more people.
Why are you still in-network with Husky and not other insurance companies?
It is a deep value of mine that I provide access to natural medicine for all people, regardless of their financial circumstances.
Also, Husky never pulls the shenanigans like the for-profit health insurances do. They are very easy to work with and they are not profit-driven so they do not benefit from playing the games that for-profit health insurance does like denying claims to delay payment or requiring my billers to call and be on hold for three hours.
General
I called BCBS and they said…
I appreciate everyone who made calls to BCBS about the downcoding situation. Unfortunately, people who called were lied to about how the coding works or told that my office submitted the bill with the lower code. The representatives acted like they didn’t know what downcoding or level of care adjustments were. I felt mad that they told people these false things and also I’m not surprised. If you called BCBS and were told something like this and you would like me to show you the level of care adjustment on your bill, you can email me at clinic@drgwennrosenberg.com.
Will you still be able to order labs and do referrals?
I will still refer you to specialists and order labs and imaging as needed. Those visits and labs/imaging will be covered by insurance as long as they are done at an in-network facility. If you have a large deductible plan, I will help you navigate discount lab and imaging services.
How will supplements work in the new system?
Supplements will continue to work as they do now where I can send a prescription through the online pharmacy (Fullscript or Wellevate) and you can get them at a discount and have them shipped to your home, you can get them at the time of your appointment or you can let us know that you would like to pick them up and we will put them out in the box for you.