I find patients who understand their financial responsibility in our office get the best results and have the best experience. For that reason I will go over some details as to how insurance works and what you can look forward to regarding your care. Remember every policy is different and my description is accurate from a general point of view. The specific coverages of your policy will have to be determined by conversation with your insurance company.

   Also, in today's day and age, most insurances are not designed to cover all of your treatment. In most cases it is a mistake to expect your insurance to pay the majority of your care, and and even greater mistake to base your treatment on your insurance coverage. That being said, let s get on to the description of the types of policies available.

   Remember, insurance is not designed to take care of your entire treatment costs. In order to help our Medicare patients I have designed a fee schedule that takes into account the deficiencies in the Medicare program. Many of my patients note that even without Medicare and their supplement, my fee schedule allows them to receive the treatment they need at an affordable cost.

   Initially, an HMO looks like a bargain. There is a monthly premium that looks reasonable. These premiums allow you to have no deductible and usually very low copays. Looks good so far. However, here is where it gets interesting. You are assigned or pick a primary care physician. This physician s job is to handle your minor health issues and be a gatekeeper for referrals for more serious conditions . He or she decides the severity of your condition and IF a referral is required. If the gatekeeper decides no referral is necessary, in most cases you have no simple way of getting further care THAT IS PAID FOR BY THE INSURANCE! Notice, I did not say you couldn t get further treatment. I said if the referral is not approved, you can still get the care provided that you pay for it yourself! For example, a few years back when I was a patient on an HMO, I had a sinus problem. I wanted to have an allergist take a look just to be sure. My gatekeeper gave me medication for the sinus condition and said that the referral was was not needed. It would just add medical expenses for the insurance that he felt was not warranted. Unfortunately, in my experience HMO s tend to make financial decisions regarding your health rather than purely health decisions. Being an HMO doctor in the past I can tell you that each month or quarter an HMO doctor gets a report notifying him of the amount of referrals he has made and the amount of procedures performed. There is incentive to have less referrals because the amount of referrals and procedures affects your pay from the HMO each month. After understanding how the HMO s worked, I decided I could not in good conscience treat patients under HMO s and still offer them the quality and quantity of care that their specific condition required. For that reason I am no longer an HMO doctor.

How can I expect HMO patients to visit me given these facts?
   Let me give you a real time example which may shock you. Let s say your HMO advertises that it allows up to 20 chiropractic visits per year. You go to your gatekeeper and he agrees that a referral is warranted. He pre approves 3 visits. You go to the chiropractors office and after examination and xray it is determined that you need more than 3 visits. Unless the gatekeeper, after another visit with him, agrees with the assessment, you will only get 3 visits paid, EVEN THOUGH YOUR POLICY SAYS IT ALLOWS 20 VISITS PER YEAR! There are other scenarios that I could mention&suffice to say they lead to the same conclusion&The HMO determines how much care they are willing to pay for, period.

How have I made the system better for you?

I furnish HMO patients a payment at the time of treatment discount . Since I am not having to communicate with the insurance company, send claims, and since there are no insurance hassles, I can afford to give you a generous discount on treatment provided that you pay for each treatment at the time service is given. I have had numerous patients who enjoy this option since they can now determine how much treatment they choose to receive and still have it be financially reasonable for them. Another tremendous benefit that you will have in my office is my office runs ON TIME!not inundated with hundreds of HMO patients that I would be required to fit into my schedule as an HMO doctor. I have time to not only help you with your health issues, but also to talk to you about these concerns.

If you have any questions, please speak to me personally by email, (info@drsantoro.com, or by telephone (495-4950) to determine what your costs will be in my office compared to your HMO costs. I am here to help you.