Lindsay Blumeyer (00:09)
Hi, welcome everyone! Good afternoon.
Just thrilled to have everyone join for another live stream. We'll just get a few moments going, get people joined in.
I’ll go ahead and just introduce myself. My name is Lindsay and I am joined today by my wonderful colleagues here. I've got Kristina and Raquael. So we'll go over our topic for today. And our clinic, Thrivelab, we do great productions here, all from our own clinical staff. And we have a lot of invited guests, a lot of topics that we cover, what we do here, our treatments, other topics regarding patients and symptom relief. My team, Raquael and Kristina, we have a privilege to work with thousands of patients and guiding them to get holistic health, everything in checked. So we’ll just get started here in a second.
Our main topic today will be insurance. It's something that we're very, very excited to cover. It's been something that's always quite challenging for patients, a very confusing aspect for many. And many of us might not know about our insurance until we need to use it. So we just want to help explain just the importance about your insurance, or what to look at, how to understand what your plan covers, costs, and things like that. So, hi Raquael, hi Kristina, how are you guys doing?
Raquael Flores (01:55)
Good.
Kristina Zappia (01:56)
Hi! Good. Excited to be here.
Lindsay Blumeyer (01:59)
Good, good. Today we will focus a lot on insurance. We do encourage you guys to enter any questions. We'll monitor that as we go. Anything related to insurance, questions that you have regarding our clinic. We do want to cover common questions that we receive, key terms and basic things related to insurance, how Thrivelab, most importantly our clinic, how we file claims, what we bill for, what that looks like. We want to cover labs and visits and medications. What does that mean? And just practical tips. So at Thrivelab, we're always wanting to improve our patient care. We do believe that hormone health, holistic wellness should be affordable and accessible nationwide. So we always also want to improve the experience and we've included insurance as our clinic to help maximize benefits for patients. So with that I think we've had some time to go in with our introduction. I do have Raquael here so I'll let her just dive in and give us more about the basics.
Raquael Flores (03:12)
Yeah, so like Lindsay touched on, there's a lot of common questions that we get about insurance. Like, does my insurance cover this? I have military insurance. Do you accept it? Do you accept Medicare or Medicaid? What if I have a high deductible? How do I handle billing, medications, treatments covered? And do I still have to pay 45 for every appointment? And what does that mean? And so I'm going to dive into terminology, the basics and we will go from there.
All right, so insurance basics. Co-pay. So co-pay is a fixed fee for services and visits. For an example, you may pay $20 for each doctor's appointment and your insurance covers the rest. Co-insurance, patient share of costs after deductible is met.
For an example, if you have a co-insurance of 20% and that service cost &100, you pay $20 and your insurance pays $80. Deductible, the amount to pay before insurance kicks in. So for an example, deductible is $1,000. You will need to pay that amount first before your insurance kicks in. For other costs, some items may go towards it, some items may not. Excuse me, based on your plan, you're gonna wanna ask insurance.
So coverage, services insurance will pay for, verification of benefits and EOB. We're going to go a little bit into that into the next slide. Verification of benefits is what we do when you first come to us and book your appointment. So we're going to find out what exactly if we're in network, out of network and if there's benefits available. Your EOB, which is your explanation of benefits, will be received by you usually about four to six weeks after we bill out for that original appointment. It's going to be a real time capture of if you have copays left, if you have deductibles left and what that balance currently is. So you will receive that information. As far as copay, coinsurance and deductible, some plants can have a blend of two or all three of these. So again, important to find out what your coverage is through your insurance. There are different types of insurance. have HMO, PPO, EPO, military, Medicare and Medicaid. Most of these have benefits available. It just depends again on your plan and where we fall in coverage. However, at this time we do not take Medicaid, which is state funded insurance. There may be some ways to unlock that with such as like your labs, if you can get your primary to order those. So there are some things that you can be proactive and maybe trying to get some coverage with that as well.
Lindsay Blumeyer (06:25)
Raquael, I think you had a good description on those, believe with deductible, think it's also important to note as we've noticed and feedback working with patients is deductibles may look different for everyone. What meets deductible, know, different services, different types of labs. So as Raquael was mentioning, you know, understanding these terms and understanding your insurance plan. Keep in mind it's all different. So it's good to always request ahead of time or look into that. What does meet, what items, services, labs go towards my deductible. Because some things may, some things might not.
Raquael Flores (07:06)
Exactly. So understanding your in-network versus out-of-network coverage. So just like we were talking about in the previous slide, just because if we do come in out-of-network doesn't mean that there isn't any benefits available for you. So that is one thing that we're checking. So in-network patients can benefit from lower costs due to pre-negotiated rates between your health care provider and your insurance provider. Out-of-network, we encourage patients to confirm coverage and potential out of pocket costs with their insurance provider when we are coming out of network. So using, you can use your FSA and HSA if you have that available for services that may not be covered such as like copays, meds, lab work. So it's important to know how to access those benefits and what is going to qualify for those services to use your FSA and HSA cards.
So, what to expect? Step one, you'll be booking that initial appointment like we talked about with the provider. We do charge, and we get this question a lot, why are you charging me $45 if I am utilizing insurance? Well, this is because we don't have the full real-time screenshot of what is available in your insurance at that time. So we charge a $45 fee, which is basically an expected copay or expected fee out of pocket that you are required to pay. So once we get those benefits back then we will adjust that amount if it is less so that'll be the EOB that we get back. If it's less than the $45 we will credit it back. If it is more than the $45 then we will bill out for the difference for that.
Step two, submitting insurance details. So insurance claim processing, and this is important to know, it can take up to 45 days after that initial appointment. However, you can still get started with us and you can still approve your plan. We're just waiting again for that real time to get to know exactly that number that you may be expecting out of pocket or owing. So step three, once verification is complete, your insurance provider will mail you that EOB or explanation of benefits for any additional co-pays, co-insurance, or deductibles associated with your health care plan. And please note that if you get your letter of explanation of benefits, sometimes you receive those quicker than we do. You are always welcome to submit those in your portal for us to see those sooner than waiting for your insurance as well.
Does anyone have any questions regarding anything or any of my fellow coworkers have anything to add to anything before we move on?
Kristina Zappia (10:24)
Just one thing, just patients with the original Medicare, that's that red and blue card. So you are exempt from that $45 booking fee if you have the red, white, and blue card. And we will ask you that when we onboard you.
Raquael Flores (10:27)
Yes, and also to note, it doesn't mean that because we're not collecting that $45 fee that you may not have any expected out of pocket. We'll know that again once we bill out to Medicare what is owed for that, but you just won't have to pay that $45 like Kristina said.
Lindsay Blumeyer (11:02)
I realize I'm on mute. I think with all of this, we just want to show the importance of this is what is to consider and what to be aware of with your insurance. So you just know terms, key terms, what to look for when you are going to a clinic or seeing a provider.
Kristina Zappia (11:21)
We understand insurance can be complicated and we are really here to help process. If myself or Lindsay or Raquael don't know the answer to your question, we will find out for you. So please don't hesitate to reach out. That's what we're here for. here to help. So leading us into the next topic is how we process insurance claims for visits. We run very similar to any provider that you're going to go see. We are able to bill your insurance for the clinical visits. But that's where we differ is we do bill for clinical visits, but we do not bill for medication. The reason is, we use compounded medication, which we'll get into further details and those are not typically covered by insurance. So just knowing that ahead of time is useful and we can go over those expected costs with you when we speak to you. So we only bill for the visits. Our clinic operates under a medical group supervised by an MD and the visits are billed using the rendering nurse practitioners and NPI for your claims. And the nurse practitioner will be the person that you're meeting with. We verify if the nurse practitioner is credentialed with that patient's insurance and they may appear in providers' portals as in network. Ultimately though, insurance companies are gonna determine the coverage and how claims are processed. We're just here to provide them the information and work with them, but we aren't the one that determines the coverage they will be. There are some things that you can do ahead of your appointment as the patient.
You can verify if your plan offers out of network benefits and understand how those benefits are calculated. So things to like Raquael had mentioned in previous slides, co-insurance, co-pays, just realize how those are calculated. You can also check with your insurance company for specific coverage details. And then again, how we support you, we're here to help. We do verify in network status during the onboarding process and this ensures accurate billing. And then we can also, the patients can also request provider or group NPIs from the team to confirm coverage directly with their insurance. And we can provide you with those NPI numbers so you can verify coverage as well. And again, we're here to help. We understand insurance is complicated. So that's what we're here for. And we love talking to our patients and resolving the issues that you might have with insurance. And I will turn the time back over to my colleague.
Raquael Flores (13:37)
I do want to, I wanted to add something on that and I know it's something we talked about before, but to be aware that we have a group NPI number and then we have an individual provider NPI numbers. So sometimes you'll see that group NPI providers name or number in there, but we're billing for your provider that you're seeing. It's how the contract process works. So if you have questions about that, you can always reach out to us and we can explain that as well. But we do get that question often.
Lindsay Blumeyer (14:16)
And with insurance and entirely with our clinic, you know, it's good to go deep into what we bill for as a clinic. We're only talking about the visits, what we process, what we're verifying and understanding what it looks like just to see the provider. And these are video calls at our clinic each time. Each time you see the provider, we do the same claim process. Now, what we don't do, as Kristina said, we don't bill for medications and we don't bill for labs, but we do need to guide patients. What does that look like for them?
them. A lot of our treatments do require lab monitoring and that is blood work. So what can we do in that process? For Thrivelab, whenever we're monitoring patients and doing blood work, we will provide a lab order. We email that to the patient and then that patient will go to a lab facility and that facility will verify and they do the insurance claims on your blood order. So what we do and recommend is you can do two types of verification. You can verify with your insurance and also verify with the lab that you're going to. So with your insurance, what you can do is call ahead, ask them what type of lab facility do they prefer you to complete lab work at? Do they prefer LabCorp? Do they prefer Quest? Are they fine with either? Do they have other lab facilities listed? So you want to go to a lab facility that's billable to your insurance. What you can do also is the facility you know that you're going to go to, you call ahead or you can email them the lab order, request them to run that through your insurance prior to completing labs. So you can get a full quote if things are covered, if there's any additional patient responsibility. We do comprehensive panels. So this is more than your annual wellness exam. This is also where criteria is different for every insurance plan. What meets deductible, what's covered. So this is where we advise patients to either request with the lab facility that you go to and always check with your insurance ahead of time. Now if patients are concerned about cost or let's say they don't have insurance, what are the options for patients going to our clinic? So one, we do accept labs from an outside provider. It just depends on the time of the labs, what information is on there. So it's per provider's discretion. We do need to review and take into consideration what we approve before we can recommend or treat based on that information. We do have a list of panels that we can send out to patients, letting them know what we typically cover. Our providers are able to add on panels requested by the patient, or if there were other things that you and the provider were looking at, it would be additional cost. Most likely, again, that's what you'd want to get reviewed by your insurance if it's something that they cover. You can also ask various lab facilities if they have different pricing. This is if you're not using insurance or you're concerned about the cost and see what price listing they have for panels. Labs can be expensive, so this is what we just want to prepare patients for. Some patients have completed labs with maybe their gyno, endocrinologist, PCP. Maybe they were able to provide the same order that we need. So we do have information that we can give to patients ahead of time, see if it's list of panels that they complete on their own. We just need to verify the panels, the provider, what's been covered in the testing and make sure everything is there just to support your treatment and your health.
As a clinic, what else we can do for labs is we can provide CPT codes. So when we do give you that list of lab panels that we typically cover on comprehensive panels, we can also provide CPT codes. We cannot do laboratory codes. So if you have any assistance, need any help, like Kristina said, just reach out to our company. We are more than happy to assist our lab coordinator, our assurance coordinator. We’re all here to support you. And then just with that, you know, what our main focus here is we understand insurance can be murky and there's gray areas and things change. We know that we're towards the end of the year. So a lot of people are looking into their plans, see if they've met their deductibles, see what type of appointments or clinics they can attend utilizing and maximizing their benefits. We also know that January 1st is coming up and there's also open enrollment for people looking for new plans or maybe switching employers. So this is where we just want to give you the tools and resources so you know ahead of time what to look for if you are considering choosing a new plan or you know that you're switching plans. Some things to consider if you're looking to join a clinic of what we provide with hormone health, nutritionists, life coaching, we also have medical grade supplements. We have a variety of treatments here. So if that's something that you're looking for and have a more holistic approach, you'll want to look at your plan and see what type of benefits those have for you. And then anything that we can do to support answer questions, you know where to find us. Do you guys have any questions? Should we start calling out, who's got PPO's?
Raquael Flores (19:32)
I just wanted to add to that too, that with our other services like dietitians, mental health, that we will verify for those as well if that is something someone's interested in. So we can do that too.
Lindsay Blumeyer (19:51)
Exactly. What if I need a referral from my primary? Perfect. So if you have an HMO, if you are on a plan that requires a referral, we are going to need to have a referral letter in order for your insurance to accept the claims. We can still make claims, but if you have a closed network, your insurance will not accept the claims until there is a referral letter on file. All plans are different. Again, this is where we need to verify and see what is allowable, who with their PCP and what your insurance will accept. And that's where every plan's different. Criteria is different for every patient. We will do our best to do any pre-op forms. Once we have that on file, we're able to make those claims and help with your acceptance for that. Any, Raquael, Kristina, do you have any? Any feedback or anything to add with that question. Great question.
Kristina Zappia (21:01)
I don't, you did a great job.
Raquael Flores (21:04)
No, I don't have anything.
Kristina Zappia (21:10)
All right. So insurance again, if you need help, let us know, but this is how you can get started today with ThriveLab. So first thing you're going to do is you're going to log on to our website, ThriveLab.com and you're going to do a quick free self-assessment. This self-assessment is really good not only for you, but also for the practitioner that you'll be seeing. You're going to tell us a little bit about your symptoms. These symptoms will let the practitioner understand more about what you're experiencing as well as what deficiencies you may have.
So that takes about five minutes. Next step after that would be booking your appointment with the provider. You do have some options here. If you are ready to book with the provider, then we encourage you to go ahead and do so. If you do, though, however, still have lingering questions or want to talk through some things, Raquael, Lindsay, and myself do offer free consultations where we can answer your questions about insurance, about treatment, and then we can go ahead and get you scheduled with the provider.
But that would be the next step is booking your 40 minute appointment with the provider. They're going to discuss all of your questions with you regarding treatment options, your symptoms, your medical history, and then she'll go over the treatment plan recommended for you, which is the third step. So these are personalized treatment plan. It's not a one size fits all. It is very much catered to you and suits your needs for hormone balancing, weight loss options, nutrition services, all of that.
We will then complete that verification of health insurance benefits as we discussed about, and then we will go ahead and order the labs when the practitioner recommends that is done. Last step will be getting the medication delivered straight to you. You don't have to go wait in the line at your local pharmacy. We will go ahead and ship everything out to you. It comes in discrete packaging. No one will know what's arriving and it's quick within seven to 10 days. And just a reminder, prescriptions are always compounded in the United States.
Any questions with that, on how to get started?
Okay, so this are just a reminder on our cost. This is all on our website, but just to give you a rundown, if you decide to book with insurance, we will be collecting the $45 at the time of booking. Then we will complete that verification of benefits to determine if there's any co-pays, co-insurance or deductibles that need to be met. The final amount for patient responsibility does differ. Again, it's all based upon your insurance plan.
Now there's a lot of people out there that don't have insurance coverage. We still want to be affordable and here to help you. So our Thrively Self-Pay option would be $94 to book the initial consultation. And that would cover that first visit with the provider, which is that 40 minute visit. We do have a platform fee. So this is going to be something that every patient will pay. It is not something that is billed to insurance. It is paid quarterly though. So it's $33 a month. We bill it quarterly. And what this includes is continuous access to your provider and patient care, on demand plan optimization, prescription management, basically all the stuff that we do to make sure that your care is continuous and that you're getting all the help that you need. And then lastly will be your continued care health, health visits. You're only going to pay the copay, coinsurance or deductible as determined by your health insurance, or if self pay is your option, it will be $45 per visit.
And then lastly, we wanna say thank you for joining us today on our webinar. We really value your time and appreciate you being here. So we wanna offer you the first three months of the Thrivelab platform fee for free. All you have to do is use code TRYTHRIVELAB when booking online, or just let one of us know that you attended the webinar and we will make sure you get that included as well. And it is valid until January 10th, so you have some time.
And again, we are here to help you guys. We offer these free consultations as a way to make sure you have all of your questions answered. We just want to make sure that you feel heard and seen throughout the entire process, and we are always happy to help.
Lindsay Blumeyer (25:18)
Nicely said, Kristina.
Yeah, the TRYTHRIVELAB code to use until January 10th here is a great offer. First thing, you you just need to see the provider, see what options we have for you. She'll do a full assessment prior to and let you know what the game plan is. They'll ask a lot of questions, answer your questions, and at least give you an idea of what we have as a clinic entirely. And you can tailor through those treatments too. So we just wanted to get you feeling good, feeling great. It's a new year, new you if that's not overdone. But it feels good to thrive so we want all our patients to thrive.
I don't see any other questions. So we do encourage you guys to reach out to us if you do feel free just to visit our website thrive lab.com. You can take a self assessment and navigate through all the information we have there. We also have podcast series. have a hormone health series. So do check out those videos. If anything is validating or interesting or something to share to a family member or friend that might be experiencing the same thing. We want to be able to help and provide the best for all you guys and we thank you and appreciate all your help.
Okay, everyone. Well, Kristina, Raquael, I think we did a good job here.
Kristina Zappia (26:47)
Thank you, everyone, for joining us. We're excited to talk to you and get you feeling better.
Raquael Flores (26:54)
Hope everyone has a great day.
