Payment and Insurance

Monthly fees are $150 per person per month which includes unlimited visits and unlimited phone calls and texts with the doctor. Further fees are detailed on our Fees page.

Prices will always be up front and transparent. We do not work like insurance, so we know all of our costs up front and what any charge may be to you. There are NO hidden fees. Most of our costs can be found on the “Fees” page of this website, but no service will ever be provided without first letting you know what the cost is to you, if there is one. We will only proceed if and when that cost is approved by you.

Dr. Kaul works primarily with a membership model with occasional fee for service items like acupuncture and integrative medicine consults. She does not participate with any insurance companies.

Dr. Kaul feels that this payment system is of greater benefit to her patients and they receive more care for their dollar, so that she can focus on superlative quality, personalized care, and a deeper one-to-one relationship with her patients. By cutting out the middlemen (insurance companies!), and remaining out-of-network, she can collaborate with patients to make health decisions without interference from insurers.

Practices that operate in the insurance model perpetuate the “quick fix” approach, putting out the biggest fire without allowing time to sort through the bigger picture or get down to the root cause. Insurance companies only pay for limited visits, so doctors who work with insurance will often ask you to come back over multiple visits to address multiple issues.

It comes down to Dr. Kaul’s belief that you should be the ultimate decision maker for you and/or your children, not your insurance company.

SO WHAT DO I DO ABOUT THE INSURANCE I ALREADY HAVE?

Insurers were originally intended to cover emergencies, severe illness and catastrophic matters. With PPOs, they also generally cover labwork, prescriptions and often some portion of insurance-based visit fees (each policy’s specific terms are different, of course).

Insurance in general (car insurance, homeowner’s insurance, health insurance) is intended to protect you from catastrophic events, but not preventive and routine matters. To use a common example, your car insurance pays if you are in an accident, but you don’t use it for your oil changes or your next regular tune-up. Similarly, your homeowner’s insurance pays if a tree falls on your roof, but not if it needs re-shingling.

Read on for more specifics about the different types of insurance you may have, and how it may work in conjunction with Dr. Kaul’s membership.

PRIVATE INSURANCES

Patients with any kind of insurance can enroll in the practice, but your insurance plan is between you and your insurance company. Dr. Kaul does not contract with any insurance plans, and is therefore considered an “out of network provider.”

Currently, your membership fee to Dr. Kaul’s office cannot be deducted from your insurance deductible. In the next six months, membership fees for DPC offices will be eligible for payment through a health savings account (HSA). Until that happens, the membership fee is an out-of-pocket cost to you, that will exponentially increase the quality of care you experience. It may be possible to use Flexible Spending Accounts, but check with your particular plan. You will continue to give your insurance information as usual to any laboratory, specialist office, or hospital for services outside of the practice.

HMO’s usually require you to have an “in network provider” for outside referrals to be covered. This may include all labs, tests and specialist referrals. Be sure to check your plan’s details regarding their practices, as this is your responsibility.

Dr. Kaul is “opted out” of Medicare. Patients with Medicare are welcome to join Dr. Kaul’s practice or to see her for consultation, but Dr. Kaul is not contracted with Medicare. Any services provided by Dr. Kaul are not covered and not reimbursable by Medicare due to federal regulations.

This means that you will need to sign a private contract and pay out of pocket. Services ordered by Dr. Kaul, such as imaging and lab tests, will continue to be covered by Medicare, as long as you are not enrolled in a Medicare HMO plan. You must find out the rules of your particular agreement.

MEDICAID

Dr. Kaul does not participate in Medicaid. Patients with Medicaid are welcome to join the practice, but Dr. Kaul does not accept Medicaid payments.

UNINSURED

Dr. Kaul knows that patients without insurance will find her practice a refreshing change. The fee schedules are designed to make primary care affordable and accessible to everyone, insured or not. She has both patients that are insured and those that are un-insured, as this is the most affordable care available with the most quality.

Questions about how this would work for you?

Contact us below for more information or to schedule your first session. Feel free to call us at 201-639-4250.

Contact Us