Insurance & Medicare Policy

WHY WE DON’T TAKE INSURANCE & UNDERSTANDING OUR MEDICARE OPT-OUT

We chose a direct-pay model so that every decision in your care is driven by what you need — not by what an insurance company will authorize.

Why We Don’t Take Insurance

Insurance was designed for acute, episodic care. Integrative medicine is something fundamentally different — it’s a deep, collaborative, ongoing partnership focused on understanding the whole person. The insurance model doesn’t support the kind of care we provide, and we refuse to let it limit what we can do for you.

What Insurance-Free Care Actually Looks Like

Removing insurance from the equation doesn’t take something away — it gives something back. Here’s what changes when your physician works for you instead of a billing department.

Unhurried Appointments

Insurance reimburses for speed, not depth. Without those constraints, your initial consultation is 90 minutes. Follow-ups are a full hour. There is no clock dictated by a billing code.

The Full Toolkit

Insurance companies decide which therapies they’ll cover — and integrative approaches like genomic-informed care, lifestyle medicine, mind-body-spirit techniques, and personalized supplementation are rarely among them. We use every tool that serves your health.

Your Records, Your Privacy

When insurance is involved, your diagnoses and treatment details become part of a system that follows you. Direct pay keeps your health information between you and your physician.

No Prior Authorizations

No waiting for an insurance company to approve what your physician has already determined you need. If a test, a referral, or a treatment is clinically indicated, we move forward.

A True Partnership

In a direct-pay model, the physician–patient relationship is exactly that — a relationship between two people. There is no third party deciding what care you deserve or how much time you get.

Transparent Pricing

You know exactly what your care costs before you walk through the door. No surprise bills, no confusing EOBs, no denied claims months later. The price is the price.

What This Means in Practice

  1. Payment is due at the time of scheduling. All services are paid in advance. Your appointment is confirmed once payment is received.

  2. We do not bill any insurance company. We do not submit claims to private insurance, Medicare, Medicaid, Tricare, or any other health plan on your behalf. You are solely responsible for payment to the Practice regardless of any insurer reimbursement.

  3. Superbills are available on request. If you’d like to seek reimbursement from your private insurer, we can provide a superbill — a detailed receipt with procedure and diagnosis codes — that you submit directly. Reimbursement is not guaranteed and depends entirely on your plan’s terms.

  4. Labs and diagnostics are separate. Laboratory testing, bloodwork, and diagnostic studies are not included in consultation or membership fees. If labs are recommended, they are ordered separately and are your financial responsibility.

Understanding Our Medicare Opt-Out

Dr. Tavernier has formally opted out of the Medicare program pursuant to Section 4507 of the Balanced Budget Act of 1997 and 42 C.F.R. § 405.415. This is a legal, voluntary process that allows a physician to practice outside the Medicare system entirely.

Dr. Tavernier chose to opt out of Medicare to provide care free from the regulatory constraints that limit visit length, scope, and the integrative therapies that are central to this practice. This allows us to offer you the kind of medicine Medicare was never designed to cover.

What Does This Mean If I Have Medicare?

It means that Medicare will not pay for any services you receive at this practice — and we will not submit any claims to Medicare or Medicare Advantage plans on your behalf. Medigap (supplemental) plans will also not reimburse for these services because no Medicare claim is being processed.

This applies to all services, whether provided in person or via telehealth.

You are not giving up your Medicare benefits elsewhere. You can still see any Medicare-participating provider for any other care. This private contract applies only to services at this Practice.

How It Works for Medicare Patients

1. Before Your First Visit

You will sign a Medicare Private Contract — a legally required document between you and Dr. Tavernier. This contract explains that Medicare will not be billed, that you are responsible for payment, and that Medicare’s fee limitations do not apply.

2. The Contract Cannot Be Signed During an Emergency

Federal law requires that this contract may not be entered into during a time when you require emergency or urgent care services. It must be signed before any non-emergency services are provided.

3. You Receive a Copy

A copy of the fully executed contract is provided to you before any services are furnished. The original is retained by the Practice for the duration of the two-year opt-out period.

4. You’ll Receive a Written Cost Estimate

Because Medicare beneficiaries are not eligible for the federal Good Faith Estimate under the No Surprises Act, we provide a separate written Cost Estimate before each telehealth or in-person service for full transparency.

5. Your Other Medicare Benefits Are Unaffected

Opting into a private contract with this Practice does not affect your ability to receive Medicare-covered services from any other provider who participates in Medicare. This contract applies only to services provided here.

Can I Get Any of This Covered?

If you have private (non-Medicare) insurance with out-of-network benefits, there is a possibility of partial reimbursement — but it is never guaranteed.

How Superbills Work

Upon request, we provide a superbill — a detailed receipt containing procedure codes, diagnosis codes, provider information, and fees paid. You submit this directly to your insurer. Whether and how much they reimburse depends entirely on your plan’s out-of-network benefits, deductible, and the insurer’s own credentialing and coding rules.

Please be aware that submitting a superbill may require your insurer to access medical records to process the claim, which could include information about your genetic testing results or other sensitive health details.

Medicare Patients

Superbills cannot be submitted to Medicare, Medicare Advantage, or Medigap plans for services provided under a private contract. These plans will not reimburse for opted-out physician services. A written Cost Estimate is provided instead for your records.

Common Questions

Is this legal?

Yes. Medicare opt-out is a formal, federally regulated process under 42 U.S.C. § 1395a(b) and 42 C.F.R. § 405.415. Physicians file an affidavit with Medicare and comply with specific requirements for private contracts. Operating a cash-based practice outside insurance networks is entirely lawful.

Am I giving up my Medicare benefits?

No. Your Medicare benefits remain fully intact for any other provider who participates in Medicare. The private contract with this Practice applies only to services provided here.

Can I use my HSA or FSA?

In many cases, yes. Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA) can often be used for qualified medical expenses, including physician consultations. We recommend checking with your plan administrator to confirm eligibility for specific services.

Why can’t you just bill insurance and also offer integrative care?

Insurance reimbursement comes with conditions — visit length limits, approved diagnosis codes, restrictions on which therapies can be provided, and documentation requirements designed for conventional acute care. Accepting these conditions would fundamentally change how we practice. The direct-pay model ensures that every clinical decision is made based on what you need, not what an insurer will approve.

What if I have Medicare and also have private insurance?

If Medicare is your primary insurer, most secondary/supplemental plans will not pay for services that Medicare does not cover — particularly when the provider has opted out. You may wish to check with your secondary insurer directly, but reimbursement is unlikely for services provided under a Medicare private contract.

Do I need to sign anything?

All patients sign an agreement appropriate to their service (consultation, membership, or follow-up). Medicare beneficiaries sign an additional Medicare Private Contract, which is required by federal law before any services are provided. You will receive copies of everything you sign.

Questions? We understand this is a different model than what you may be used to. We’re happy to talk through any questions before your first visit.