FAQs for Members
Do you accept insurance?
We do not accept insurance. Depending on your membership level, your program may include your medical visits and services. If the services are not included, you are responsible for paying each service based on our fee schedule.
Why do you need to have my insurance card on file if you do not accept insurance?
We use your insurance card to help you obtain prior authorizations for your insurance to cover diagnostic imaging, tests, medications, and medical care outside of PALM. Your labs will be processed by Quest or LabCorp, who will submit them directly to your insurance.
Will insurance cover my labs?
Routine labs submitted through Quest or LabCorp will be paid by your insurance according to your plan. Specialty labs are typically not covered by insurance. PALM is not able to provide Insurance Correspondence Forms (“Superbills”) for the majority of specialty labs. Before your specialty lab, you will receive a billing acknowledgment form to clarify the fees that you are responsible for paying at the time of service.
Can insurance reimburse any of my visits?
For certain services, we can provide Insurance Correspondence Forms, known as “Superbills.” The forms include the necessary diagnostic and treatment codes so that you may submit to your insurance company for reimbursement. However, we cannot guarantee repayment even with the Superbill. Of note, if your visits are included in your membership program, we cannot provide you with an Insurance Correspondence Form (“Superbill”) for the individual service.
Which services can I submit to insurance for reimbursement?
We can provide Insurance Correspondence Forms (“Superbills”) for the following services:
- Chiropractic Care
- IV Therapy
- Nutrition Counseling
- Physical Medicine and Rehabilitation*
- Preventative Cardiology*
*We cannot provide Insurance Correspondence Forms for services included as part of your membership program fee.
Who should I contact to obtain a Superbill?
Your provider can give you an Insurance Correspondence Form during your visit if your service is eligible for a Superbill. If you seek to obtain an Insurance Correspondence Form after your visit, please contact our accounting department at email@example.com. We can provide insurance correspondence forms for services completed within the last six months.
What tests or procedures are included in my membership?
The tests or procedures included depend on your specific membership program. If your program includes primary care, the majority of your medical care completed at PALM Health, such as EKGs, ear cleaning, wound cleaning, joint steroid injections, as well as some point of care tests such as strep, mono, and flu, are included at no additional fee. The flu vaccine, as available, is included as well. Of note, COVID-19 testing, pneumonia vaccination, shingles vaccination, hepatitis A vaccination, TDAP vaccination, prolotherapy, and vitamin B12 shots are not included.
Suppose a procedure, medication, or vaccination is not included. In that case, we can provide you with an Insurance Correspondence Form to seek reimbursement or refer you to another place, as preferred.
Can I use a Health Savings Account or Flexible Spending Account to pay for my membership program or services?
In some cases, PALM’s fees may be paid for using your employer-based Health Savings Account (HSA) or Flexible Spending Account (FSA). Contact your health insurance representative for specific details on your HSA and FSA benefits coverage.
Do I need health insurance if I have a PALM Health membership?
A PALM Health membership does not replace health insurance. We advise all members to maintain a separate health insurance plan of their choosing for blood work, diagnostic imaging, urgent care, emergency room visits, medications, hospitalizations, surgery, and other medical care outside of PALM Health.
Does PALM Health meet the Affordable Care Act (ACA) requirement for health insurance?
No. PALM Health is not health insurance and is not a substitute for comprehensive health insurance. Given that our service does not fulfill the ACA’s health insurance requirement, we encourage everyone to maintain a separate health insurance plan to meet their needs.
FAQs for Staff
Will there be any co-pays collected?
No, not after January 1, 2021.
How will members pay for medical visits?
Some membership programs will include all medical visits (except psychiatry). If medical visits are not included then we will have a fee schedule for each visit type, and members will pay at checkout in MindBody.
Will the fees for medical care be billed through Athena or MindBody?
Medical care and visits that are not included in the price of membership will be billed through MindBody at the time of service.
Will PALM continue to use Athena?
Yes, we will use Athena for the following:
- Electronic Medical Record charting;
- Secure Portal for patients to communicate with their doctor and for PALM to release records securely (HIPAA compliant platform);
- Medication Prior Authorizations (which Athena provides additional support on);
- Imaging and procedure Prior Authorizations (which Athena provides additional support on);
- Ordering and receiving test results;
- Coordination of Care: The Athena chart is exportable and medical records can be faxed to outside providers and insurance companies as requested;
- Athena fax and scanning for:
- All incoming faxes to the medical clinic are sorted and labeled by Athena and uploaded into respective charts;
- All paper forms can be scanned and housed.
What about existing Medical and Total members? Will they have to pay for their visits after January 1, 2021?
After January 1, 2021, their functional medicine and primary care visits will be included. Starting February 1, 2021, they will pay a fee for specialty visits such as psychiatry, neurology, cardiology, and physical medicine and rehabilitation.
What should I do if a member has questions or concerns about the change of our membership model?
We understand that this is a significant change for our members and employees. Please refer them to speak with a Navigator, who can assist them with all their questions and concerns. Additionally, please also let the Navigator Team (firstname.lastname@example.org) know the patient’s name and that they have a concern or question, and any details, so a Navigator can proactively reach out to that person.