At the Kaplan Center for Integrative Medicine, we have chosen to work outside of commercial insurance plans. By doing so, we have realigned our priorities with yours: returning you to optimal health.
Please note: If your insurance policy has out-of-network benefits a portion of our charges may be covered. Before your first visit, talk to your insurance company about your out-of-network benefits and what they include, as every plan is different.
To help our patients file accurate claims for reimbursement, we provide detailed billing forms containing all of the appropriate codes to submit to your insurance plan. For those who would like us to submit the claims on their behalf, we are happy to do so for an additional charge.
Some of our practitioners are “Non-Participating providers” with Medicare, but Dr. Kaplan, Dr. Lilienfield, and Dr. Wills have “Opted-out” of Medicare. Dr. Sheehan accepts Medicare patients, however, some services are not covered. We are not accepting Medicare Advantage patients.
More information is provided below in the FAQ’s, or you can call our office to discuss in detail with a new patient coordinator at 703-532-4892, Option 2.
2) The Kaplan Center’s other medical providers, including our Physical Therapists, are non-participating with Original Medicare. You will pay the limiting charge for covered services and for any non-covered charges at the time of treatment. We will submit to Medicare for your reimbursement. We are not accepting Medicare Advantage patients. Our providers are not directly contracted with any Medicare Advantage plan.
3 The Kaplan Center’s Psychotherapist, Jodi Brayton, does participate with Original Medicare. We are not accepting Medicare Advantage patients. Our providers are not directly contracted with any Medicare Advantage plan.
4) We have 2 provider types who are not permitted to bill to Medicare. These providers are our massage therapist and our Acupuncturist and Diplomate of Oriental Medicine, Rebecca Berkson, LAc.
- “What is my out-of-network deductible?”
- “Is my out-of-network deductible separate from my in-network deductible?”
- “What is my coinsurance?”
- “What is the maximum amount of out-of-pocket expenses I will be required to pay annually?”
For example, M-Lend is one service that offers financing options for your healthcare expenses. M-Lend advertises that it offers low-interest rates and no interest financing to individuals with good credit. If you are interested, please visit //www.mlendfinance.com/ to explore your options, or call M-Lend at 888-474-6231. Other financing services are also available, so please let us know if we can be of assistance should you find one that meets your needs.
The Kaplan Center is not affiliated with M-Lend in any way and has no financial relationship with it (or any other lending service). This is not an endorsement of its services. Information and the link provided does not imply endorsement of M-Lend’s services and is presented by Kaplan Center without any representation, guaranty, or warranty regarding its services. As with all important financial decisions you should proceed carefully and/or consult with a financial advisor before making any decision.
Fee Slips and Services
There are exceptions to the fee-for-time guideline: Several medical procedures have pre-set fees, which are explained to patients prior to scheduling their procedure. An example would be an appointment for PRP (platelet-rich plasma) therapy.
- Preauthorization for MRI and CT scans
- Preauthorization for prescriptions
- Prescription rejections requiring appeal either by letter or by peer-to-peer calls to physician’s phone
- Processing prescription requests
- Referrals to other physicians
- Same day callbacks by our doctors and nurses
- Patient portal access and communications
- After hours physicians on-call service
- Filling out forms and provision of routine letters (disability, school, work restrictions, etc.)
Patients of Dr. Lilienfield* will be charged quarterly via credit card. To access the form that must be filled out and kept on file, please visit: https://kaplanclinic.com/cc-auth/
*Fee is already incorporated in Dr. Kaplan’s membership practice. Dr. Kaplan’s patients will not be charged additionally.
“My office visit was billed with the “25-modifier” to indicate that the office visit was a distinct and separately identifiable service from the medical procedures my doctor performed on the same date (probably Acupuncture and/or Osteopathic Manipulation). My claim was inappropriately denied (or bundled) because the “25-modifier” was incorrectly disregarded. Please send this claim back for reprocessing.”
- The date you called,
- The name of the person with whom you spoke,
- What was said, and
- Ask for a reference number for the call.
If you receive your insurance through your employer and you find your claims are being routinely/repeatedly denied, you should report the problem to your company’s Human Resources Department, so they can intervene on your behalf. Otherwise, you should consider finding a new insurance carrier.
On the other hand, when the Kaplan Center files your claim, we do so in your insurance carrier’s preferred format, either electronically or on the “CMS 1500 Form.” Treatment and diagnostic codes are correctly matched and ranked. These claim forms are almost always electronically “read” and automatically processed. The result is that most of the claims we process are decided and paid quickly.