Dr Wells explains why Wells Medicine does not accept insurance and discusses ways of pursuing coverage on your own.
Insurance coverage at Wells Medicine
We don’t accept insurance at Wells Medicine for several reasons.
We want prioritize patient care. It can make a big difference when only decision makers are the patient and the physician providing care determining whether the patient needs a treatment or how much they need. Insurance companies tend to dictate care to a substantial degree when they are involved.
Another reason is that a lot of insurance companies don’t cover many of the interventional treatments we offer, or they cover them only through a cumbersome process, or they only cover them only for patients who meet a very strict criteria that not many patients are able to meet or to sustain, or they only cover a portion of the cost. In other words — the coverage is so hard to obtain, and meager and spotty when provided, that we would not be able to provide the treatments and services we do under an insurance-based model.
We provide direct patient care with transparent cash pay pricing that we believe is the best way to provide care for our patients.
pursuing Reimbursement
Some people choose to pursue insurance coverage for treatments they receive. We’re happy to provide our patients with a statement called a superbill — a document that describes the care you received at Wells Medicine, with information that an insurance company would recognize. This includes things like CPT codes and related information for the office visit and treatment. These documents allow patients to seek reimbursement from their insurance companies for costs they’ve incurred.
We encourage patients to discuss with their insurance companies whether they may be able to receive partial or full reimbursement. We’ve had many patients see a portion of their treatments costs covered. Coverage heavily depends on your specific insurer, which can become very complicated very quickly.
For example, we may have a patient tell us they have Blue Cross Blue Shield. However, Blue Cross Blue Shield of Texas treats ketamine very differently than Blue Cross Blue Shield of Massachusetts. Even for patients who live in Texas, if they work for a company that has Blue Cross Blue Shield of Massachusetts, they may be covered differently than if they did have Blue Cross Blue Shield of Texas.
Even if you have an insurance provider such as Blue Cross Blue Shield, if your company is also self-insured — meaning your employer is covering the cost of insurance and using the insurance company as a sort of benefits manager — your company is much more likely to pay for out-of-network benefits. However, it’s up to you to discuss with your human resources manager whether or not your company is self-insured, because this information is often not included as part of your benefits package.
These examples demonstrate some of the complications and individual circumstance that accompany pursuing reimbursement.
Moving Forward
We work hard to provide exceptional treatment options at a great value to our patients. That includes a direct patient care model without insurance coverage through our office.
It seems that more and more companies are moving toward increased coverage for interventional procedures including those that we offer — especially ketamine infusions and TMS.
For patients who wish to pursue reimbursement, we provide documents and resources to support these efforts — including third-party support services for guidance on your specific plans and help navigating most of the complexities of reimbursement requests for you.
Learn more about coverage and how to pursue reimbursement with your insurer.
Learn about opportunities for financial assistance for treatment through ketamine research or sponsored SGBs for qualifying patients.
About Us
Wells Medicine is a Houston-based practice designed to provide meaningful care for mental health. Providing targeted interventional treatments for Depression, Anxiety, OCD, PTSD and other conditions, with Ketamine Treatments, Stellate Ganglion Blocks, TMS, and Nitrous-Oxide Treatments. Focused on comprehensive care and integration with Psychiatry, Psychology, and Support Services. We are evidence-based, patient-focused and mission-driven.
The content here is for informational purposes and should not be relied upon for medical decisions. For the details of your specific medical conditions and treatments consult your doctors or other qualified healthcare professionals.
