Insurance Policy

Elisa Yao, M.D. PC operates as a self-pay telemedicine medical practice and is not contracted with any insurance companies (therefore, Dr. Yao would be considered an out-of-network provider). This allows Dr. Yao to provide the type of personalized service that her patients value and that is integral to holistic healthcare.

Having been in network with insurances while practicing functional medicine for over 7 years in the past, Dr. Yao knows first hand that health insurance companies do NOT value the time that doctors spend with patients. It is not uncommon that 30-minute prolonged visit codes are denied, meaning that Dr. Yao was not compensated for the extra time and effort she spends teaching her patients. And when insurance do reimburse, it usually does so 3-4 months afterwards, sometimes up to a year later.  

However, Dr. Yao recognizes the importance of spending quality time with patients so that she can give individualized care, provide health education, and answer all questions. Additionally, by default, functional medicine is particularly time consuming, because rather than focusing on just one body part at a time or simply prescribing a medication, Dr. Yao is addressing the WHOLE person and providing lifestyle counseling. At each appointment, Dr. Yao likes to check in on her patient's diet, energy level, stress level, and she spends time analyzing women's charts, reviewing labs, among many other things. Furthermore, post appointments Dr. Yao spend much time generating detailed visit summaries so that her patients have clear instructions. Because of the above, most functional medicine doctors find it necessary to operate outside of the insurance model. 

The insurance model works for doctors who do a lot of procedures or doctors who see patients every 10-15 minutes, because insurance reimburse doctors much better based on procedures or based on volume. However, most patients seek out Dr. Yao precisely because she does not push patients out after 15 minutes.  

Dr. Yao does not perform procedures and has low volume of patients. A day with four 60-minute follow-ups is a very busy day for her because of the additional time she spends after each visit to provide clear written instructions for her patients. Therefore, in order for her functional medicine clinic practice where she spends up to 120 minutes for new patient consults and 45 minutes for follow-ups to be sustainable, Dr. Yao needs to operate outside of the insurance model.

It is expected that payment is collected on the day of the appointment, after the visit. Exceptions are for the monthly installed payments for a Program. The first installed payment will be initiated at the time when Patient decide to book the Program, and will be put on a monthly payment schedule for the duration of the Program. 

Upon request, a detailed statement (Superbill) that contains diagnosis and procedure codes can be provided to assist you with possible insurance or FSA reimbursement. Some direct pay functional medicine practices do find that most of their visits are covered as an out-of-network provider by PPOs, which can allow for 50-80% reimbursement (after any applicable deductibles and/or copayments have been met). However, we cannot assure you that any of our services will be reimbursed, and this practice will not file insurance paperwork on your behalfHMO insurance will not cover our services. 

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