Health Insurance

The Weight Loss & Diabetes Center is an out-of-network provider. This means that we do not bill insurance companies directly BUT your counseling and medical services are likely eligible for reimbursement through your out-of-network benefits, medical spending or health care savings accounts.

Many medical weight loss business in Maine have closed, as health insurance companies did not reimburse them at a rate substantial enough to keep the business afloat.  Further, the Weight Loss & Diabetes center hires only leading experts and specialists in weight loss and diabetes. Unfortunately, health insurance does not cover the specialist’s services at a rate which allows us to hire the world’s best either.

What this means for you is that if your health plan has out-of-network benefits, you will likely be covered for some or all of your services. Payment is due in full at the time of service but we do everything in our power to maximize the rate and speed your health insurance company reimburses you. We work with a business partner, AdvancedMD, who specializes in electronically submitting out-of-network claims for you. You do not have to do the leg-work of navigating the out-of-network system. We do it for you.

Unfortunately, we can never forgo collecting payment at the time of service and then submit your bill, as submitting for reimbursement when the services have not yet been received is illegal.

Because some people (e.g., HMO plan participants, Medicare participants) do not have an out-of-network benefit we have lowered our charges to a fair and equitable rate so that we can be of assistance to the most people we are able to.

If you do not have an OON benefit your are unlikely to be reimbursed. A simple call to your insurance company asking if you have out-of-network benefits is all that is necessary. Further, if you would like to know exactly how much you will be reimbursed, we can provide you with the diagnosis and treatment codes you will likely receive and, by law, your insurance company must provide the dollar amount they will reimburse you.

There are two additional benefits to our being out network you probably were unaware of:

  1. Health insurance companies can review all patient records of their in-network medical practices at their discretion. By paying privately or out of pocket, we can assure our clients of the highest degree of privacy, flexibility and control of their health record allowed by Maine state law, since our records are exempt from insurance reporting and random compliance audits. Our work is off record.
  2. Despite not being the experts, health insurance companies control their in-network providers ability to deliver care by telling them what services they will, or will not pay for.  We are experts but work collaboratively with you to decide treatment and you decide what you want to focus on. Together, we have the control, not the insurance company.