09/29/2023
When I left Columbia to start a private practice in January 2015, it was a dream come true. I was able to spend as much time with families as they needed, without an administrator admonishing me for taking too much time with my patients. Over the last eight years, I have kept my office overhead low, and was, therefore, able to provide medical care to families of which I am proud, while maintaining participation in most insurance plans..
However, with costs rising, and insurance reimbursement declining, low overhead is no longer sufficient. There are significant disparities between what is negotiated with insurance companies by hospital systems and paid to them and their partnered medical offices, and what is offered to a stand-alone physician. Further, hospitals subsidize their insurance reimbursement with philanthropy and facility fees, neither of which are options for a private practice. There is no negotiation possible, and the disparity is so large that it is no longer feasible for me to remain participating in insurance networks. As a result, as of January 1, 2024, I will be out-of-network with all insurance plans.
I will be charging the same fees in 2024 that I have been charging for my out-of-network appointments for the last three years. A follow-up appointment will continue to cost $250, with other care to be prorated $250/hour for reviews of results, explanations and/or recommendations for prescriptions with you, as well as communicating with pediatricians and insurance companies. A "Superbill" will be provided to you following every visit and interaction, which you can submit to your insurance plan for out-of-network reimbursement of your payment.
For those of you who have out of network coverage that is reasonably comparable to in-network coverage, costs should not change greatly. For those of you with a much higher deductible for out-of-network coverage, or without out of network coverage at all, this communication is intended to provide you with sufficient notice to plan for your child's care in 2024 - either by changing to an insurance, as possible, that has out of network coverage, or to find a new endocrinologist. I would be delighted to continue to see your child through the end of the year, but understand if a transition to a new practice is something you'd prefer to do sooner rather than later.
It has been my honor to have your trust in my advice for your child's medical care. I pray that this communication is taken as intended - to maintain honesty and transparency from my end, providing you with all the information you need to make choices in your child's care that is right for them, and for you.
