FAQ #1: "Why don't you accept my insurance?"

Why we probably don't accept your insurance:

At one time James A. Simon, MD, PC (our practice) accepted most insurance company payments, but insurance industry changes have caused our practice to carefully review the insurance plans that we accept.  While we are faced with increased office expenses each and every year, our payments from various insurance companies and their affiliates had not increased in many years.  We worked very hard and in good faith with the insurance companies to obtain reasonable rate increases even “going the extra mile” to hire a professional insurance negotiator to work on our behalf. However, we were uniformly unsuccessful in our negotiations.  Unfortunately as a result, we had to terminate our participation with nearly all the health insurance plans (see below).

We sincerely appreciate the trusts that of each and every one of our patients (many of whom have been with us for more than 30 years) have in us. We also understand the high costs of healthcare particularly in this difficult economic climate. So, the practitioners in our practice agreed to reduce the amount we charge our patients “across the board.” From blood tests and office visits to major surgery, we cut our charges. That’s right, we reduced our fees to our patients in an effort to “lighten the blow” of not participating with the insurance plans.

If your health plan provides benefits for “out-of-network” providers, we sincerely hope you will consider our practice.  At the end of each office visit you will simply pay our office, and our front desk staff will provide you with 2 copies of the encounter form (which lists itemized fees and diagnoses): one for the patient’s records and one to submit to their insurance company. You then submit the paperwork to your insurance company and receive your reimbursement directly from them.

You may also have a choice of insurance coverage during “open season” at your job.

James A. Simon, MD, PC currently accepts the following insurances:

    * First Health
    * Unicare
    * NCPPO
    * Medicare
    
For new patients, we recommend that you check with your insurance company in advance regarding their policy for “out of network” benefits.

James A. Simon, MD, PC, its employees and staff, are conscientious about the cost effectiveness of running an efficient medical practice.  Our goal is to offer our patients superior service at a great value.  And, when that value is taxed by expensive insurance practices, the patient loses in the long run.

It is our hope that you will choose our practice.  We continue to expand the quality and scope of health care services provided to our patients. We understand that finances often limit one’s choices, but we feel strongly that the importance of one’s health far exceeds the modest cost differential between your health plan’s benefits and our reduced charges. We welcome your questions.  Should you need to speak with us or wish to make an appointment, please feel free to call at (202) 293-1000.