October 1, 2023

Dear Valued Patients and Families of GTW/YM Health and Wellness Dallas,

We hope this letter finds you and your family in good health. We are writing to inform you of an important transition taking place in our billing system that may affect your healthcare decisions in the upcoming months. Starting January 1, 2024, our adolescent and young adult medical practice location in Dallas will transition to a fee-for-service billing structure. We will no longer be considered in-network providers for any commercial insurance plans.

Instead of our practice filing claims to your insurance for payment, patients will be required to pay directly for services received at the time of the visit. We will provide you with a statement you may send to your insurer to request reimbursement directly to you in accordance with your plan benefits for out-of-network care. Please note these changes are specific to the DALLAS OFFICE ONLY. At this time, the independent Fort Worth and McKinney practices will continue to file insurance as usual as in-network providers.

We understand that this is a significant change. We want to ensure that you are well-informed about how this may potentially affect your open enrollment health insurance choices. Depending on your plan, some services may be covered fully or partially, while others may not. We strongly recommend that you review your current health insurance plan and consider any necessary adjustments during the open enrollment period to ensure your coverage aligns with your family’s healthcare needs.

You may be wondering why we are making changes at this time. For 18 years, we’ve served this DFW community (and beyond) with our unique blend of personalized adolescent and young adult health care; we can proudly say that, to our knowledge, no healthcare entity in the region provides coordinated, comprehensive, personalized care like Girls to Women/Young Men’s Health and Wellness. Economic forces in healthcare make it nearly impossible to continue to provide this level of service based on the current insurance payment rates. Eliminating the insurance “middleman” will trim hidden costs, mark-ups, and admin fees that put strain on the doctor-patient relationship and make it difficult for a small boutique practice like ours to keep our doors open and recruit new providers to continue to serve you over time.

We truly anticipate this change has many benefits, including:

• Increased appointment availability:
  • more same-day and next day appointments
  • more urgent sick visits (resulting in less need to use urgent care clinics)
• Shorter wait times, ability to answer more phone calls in real-time, faster turnaround times for prescription refills
• Improved continuity of the care we provide (more wellness visits, opportunities for parent counseling/coaching, virtual visits, and health education programming)
• Transparent costs (Prices can be found here)
• Ability to offer sliding scale or payment plans for families with significant needs (upon request) and discounts for teachers, active duty/retired military and first responders (and their families)
• Ensuring our practice remains healthy and viable to provide services to you for years to come

In order to continue offering the kind of care we provide, we may have to limit the total number of patients in our practice until we are able to bring more practitioners into the practice. To reserve your spot in for 2024, please click here.  There is no fee associated with enrolling.

Our team is dedicated to working with you to navigate this transition and answer any questions you may have. Please do not hesitate to contact us at info@gtw-health.com or via the secure patient portal if we can be of help.

Thank you for understanding that this is a decision taken after serious and thoughtful consideration for how we can best meet the needs of our patients and their families for years to come. Our commitment to providing the highest quality care remains unchanged. We are humbled by and are grateful for the trust you have placed in us; we look forward to being able to continue serving you in the future.

Warm regards,

Kwabena “Bobo” Blankson, MD                     Dana Rubin-Remer, MD                    Susan Sugerman, MD, MPH

FAQ’s

What is Fee-for-Service billing?

Instead of GTW/YM Health and Wellness Dallas filing claims to your insurance for payment, patients will be required to pay directly for services received at the time of the visit (cash and some credit cards accepted).

How much will it cost?
Charges will be based on the specific care and treatments provided during each visit. We are grateful for our patients’ who recognize the value of and can pay for the services we strive hard to provide. Be assured it is our desire is to turn no one away. We are pleased to also offer a discount for teachers, active-duty or retired military, first responders and their families in recognition of their service. For families needing financial assistance, please contact our team to discuss sliding scale or payment plans so we can best accommodate your needs. Prices can be found here.

Can I still use my insurance?

We will no longer be considered in-network providers for any commercial insurance plans. After each visit, we will provide you with a receipt/statement which you may send to your insurer to request reimbursement directly to you in accordance with your plan’s benefits for out-of-network care.

What does it mean that GTW/YM Health and Wellness Dallas is out-of-network?

For individuals with out-of-network benefits, their plan may reimburse the patient directly for certain services delivered by an out-of-network provider based on plan-specific allowances (co-pays, co-insurance, or deductibles may be different compared to in-network providers). Patients who do not have any out-of-network benefits may not be eligible for insurance reimbursement from their health insurer. We encourage you to contact your insurer directly for more information.

Why now?

You may be wondering why we are making changes at this time. Economic forces in health care make it nearly impossible to continue to accept insurance rates for the level of services we provide. In times of increasing costs for staff salaries, rent, and supplies, insurance payments have not kept up with the requirements for maintaining a medical practice. In fact, our practice payment rates from insurers have been stagnant, with actual average increases of only 0.5% (1/2 of 1 percent) in the four years between 2019 and 2023. We feel confident that eliminating the insurance “middleman” will trim hidden costs, mark-ups, and administrative fees that put strain on the doctor-patient relationship and make it difficult for a small, boutique practice like ours to keep our doors open.

Why stay? (What does GTW/YM provide that is different from other primary care or specialty care practices?)

Since 2005, we’ve served the DFW community (and beyond) with our unique blend of personalized adolescent and young adult health care. We can proudly say that, to our knowledge, no healthcare entity in the region provides care like Girls to Women/Young Men’s Health and Wellness. We will continue to provide our usual services including:

• Annual Wellness/Preventive Care (including review of history, immunizations, laboratory testing when appropriate; update of chronic conditions and current medications; comprehensive health behavior screening for nutrition, body image, sleep, academic/work issues, relationships, mental health, sexuality concerns, risk behaviors; developmentally appropriate patient and parent health education)
• Acute illness visits to diagnose and manage most routine illnesses (including upper respiratory infections, sore throat, mononucleosis, fever, urinary tract infections, rashes, gastrointestinal symptoms)
• Evaluation and management of many intermittent and chronic medical conditions (such as acne–including Accutane medication management, simple asthma and allergic conditions, migraines, POTS, Ehlers-Danlos Syndrome)
• Coordinating care for chronic conditions or disabilities (Down Syndrome, William Syndrome, etc.)
• Comprehensive mental and behavioral health care, including assessment and treatment plan coordination, medication management when appropriate (or in coordination with psychiatric professionals) for conditions such as ADHD, anxiety, and depression (mild to moderate severity)
• Integrated medical and mental health care for patients with eating disorders, including medication management when appropriate
• Care coordination with multiple specialty providers at our office and throughout our community
• Complementary Medicine, such as medical hypnosis
• Parent consultation/coaching

What about vaccines?

Vaccine products are outsourced to VaxCare, an independent company which provides and bills for the immunizations through most commercial insurance plans. All vaccine charges will be billed directly by VaxCare.

Will GTW/YM still provide procedures such as contraceptive implants and IUD’s (LARCs)?

Absolutely. Nexplanon, Mirena, and other IUDs will be ordered through specialty pharmacies which contract with most insurers and work with patients directly to facilitate payment in-network for these devices. Patients will be responsible for payment of insertion/removal procedure fees directly to GTW/YM on a fee-for-service basis.

Does this change affect the therapists, dietitians, and other specialists in the office?

All of our affiliates are independent practitioners who co-locate their services in our space so that we can work together to best coordinate care for our patients. This change does not affect their individual billing practices.

What about GTW/YM Health and Wellness offices in Fort Worth and McKinney?

Please note these changes are specific to the DALLAS OFFICE ONLY. At this time, the independent Fort Worth and McKinney practices will continue to file insurance as in-network providers.

Will there be students participating in my care?

GTW/YM Health and Wellness Dallas is proud to participate in training of healthcare professionals. Over the years, we have had the privilege to help educate and influence a large number of future physicians, physician assistants, nurse practitioners, medical assistants, and others. As always, these students work closely with supervising physicians who remain directly responsible for the care of their patients.

Why is this better for me?

We truly believe this change has many benefits, including:

• Increased appointment availability:
  • more same-day and next day appointments
  • more urgent sick visits (resulting in less need to use urgent care clinics)
• Shorter wait times
• Improved continuity of the care we provide (more wellness visits, opportunities for parent counseling/coaching, virtual visits, and health education programming).
• Transparent costs (prices will be posted on our website in the coming months)
• Ability to offer sliding scale or payment plans for families with significant needs (upon request) and discounts for teachers, active duty/retired military and first responders (and their families)
• Ensuring our practice remains healthy and viable to provide services to you for years to come

Is there a limit on how many patients can be part of the practice?

In order to continue to provide high quality care, we may need to limit the number of patients within the practice until we can hire more providers to accommodate the demand. To reserve your spot in the practice for 2024, please click here or visit https://www.surveymonkey.com/r/FVBK7NG. There is no fee associated with enrolling.