Welcome to Rebel Med NW
Pricing Transparency
Rebel Med NW has chosen to structure itself as a hybrid/concierge practice so that we can continue to sustain our clinic operations as a small business, respectfully pay our providers and support staff, and continue to be here as a comprehensive health resource for our community.
Not every insurance company provides benefits for all services as performed by our providers, as insurance focuses on this disease-centric model for healthcare. Rebel Med NW focuses on primary care with a preventative, mind-body, and functional medicine approach to health and wellness. We find that this saves you time and money as a true investment in your health and well-being.
Below you will find insurance information, a list of non-covered procedures, direct pay pricing, and concierge memberships. Please review if your insurance covers the services you are requesting or have been prescribed. If your procedure is not covered by insurance, we provide a transparent pricing structure at a discounted rate for direct-to-patient billing. We also offer discounts for seniors, military, and low-income patients.
If you have any questions, please reach out to our Billing Team account in the Patient Portal.
Billing Resources
Concierge Memberships
Integrative Concierge Medicine Benefits
Each Monthly Membership Includes the Following
Your primary care physician should be there to go to bat for you when your insurance company denies your prescription, prior auth coverage, and more. We pride ourselves on knowing the ins and outs of how insurance companies behave and how we can stand up for you. While not all services we provide may have benefits from insurance, our concierge membership plans allow you to have that fixed monthly budget so you have a team member on your side.
Rebel Med NW is proud to offer a straightforward concierge membership that allows you to mix and match non-covered services that your insurance doesn’t provide benefits for, such as:
- Dedicated PCP/ND Specialist, pick from one of our ND providers.
- Waived Admin Fees, additional fees such as blood draws, and form fees.
- Discounts on Supplements and direct pricing labs through Quest.
- Direct Messaging Access to your doctor for quick questions.
- Extended Appointments as needed
- Vitamin Injection included monthly, pick from B12, B Complex, & more.
- Accumulate Credits for access to your choice of non-covered services such as Biofeedback, IV Nutrient Therapy, or aesthetic services.
- More Access to Wellness Based Visits than traditional primary care: mind-body medicine, acupuncture, & physical medicine.
| Silver $150/month |
Gold $250/month |
Platinum $350/month |
|
|---|---|---|---|
| All admin fees waived, form fees waived, blood draw fee waived | ✓ | ✓ | ✓ |
| Select an ND as your concierge doctor for as needed questions outside of office visits | ✓ | ✓ | ✓ |
| Prepaid Vitamin Injection/monthly ($30 value), each additional injection ingredient only $20 | ✓ | ✓ *or 1 credit |
✓ *or 1 credit |
| Credits for non-covered services *See Credit List **Credits Roll Over |
2 | 6 | 10 |
| Discount on Supplements | 10% | 15% | 20% |
| Discount on Direct Pricing Labs | 10% | 15% | 20% |
| Unlimited Spinal Manipulation Maintenance/Wellness Visits | ✗ | ✓ | ✓ |
| Ideal for patients with Insurance that provide | benefits for core services (Premera/Regence/BCBS) or need minimal wellness/maintenance care |
minimal alternative benefits for core services (Aetna/Cigna/Kaiser) and need moderate wellness/maintenance care. | minimal alternative benefits for core services (Aetna/Cigna/Kaiser) and need more advanced wellness/maintenance care. |
| Ideal for | Wellness maintenance care | Have no in-network insurance with our office, and want a fixed support strategy for wellness care that includes ND and Acupuncture coverage pre-budgeted to get you back on track | Have no in-network insurance with our office, and want a fixed support strategy for wellness care that includes ND and Acupuncture coverage pre-budgeted to get you back on track |
In Network Insurance & Potential Benefits
Please note that insurance benefits vary from plan to plan. To know for sure, please contact your insurance or visit their website to find out if the below evaluation and procedure codes are covered. Here is a helpful worksheet to use during your research. In addition, an administrative fee will be billed directly to the patient to process the insurance billing and communications.
Administration Fee
In order to take insurance, provide billing-related services, including processing claims, denials, prior-auth, merchant service-related processing costs, insurance benefit checks, provider communication, and labor support to pay our staff fair and equitable wages, we have instituted the following Administrative Fees in addition to any patient responsibilities (copay, co-insurance, deductible, or non-covered procedures) performed and submitted to your insurance carrier. These fees are not covered by insurance and are typically 10-20% of the facility fees at major medical institutions.
- Acupuncture visit standard (60min) $25
- Acupuncture visit Comprehensive (75min) $50
- Physical Medicine Visit $25
- Naturopathic visit Standard (30min) $25
- Naturopathic visit Comprehensive (60min) $50
- Massage visit $25
This admin fee is waived if using a Rebel Med NW Concierge Membership. This administration fee provides you the support services for 1-week post-visit, including communication with your provider regarding your care.
What does the Administration fee cover?
The admin fee covers the cost our office incurs for billing your private insurance plan, as it has become increasingly more expensive to bill insurance, and the costs incurred for claim submission, re-submission, billing fees, prior-auth time, and merchant processing fees for payment collection. In addition this non-covered service provides added communication between you and the provider through the patient portal.
Does insurance cover this fee?
No, This fee is to sustain the operational support it takes to be able to even bill insurance in the first place. As a small business primary care facility, we agree that patients want to use their insurance where possible for medically necessary services, but due to insurance reimbursement rates not rising in the last 10 years, we have to pass some of this operational cost on to be able to sustain operations, while still being able to accept some of the insurance-based care. Consider the Rebel Med NW Membership for added benefits at our office.
Extended time visits / Comprehensive Lab review Visits
When no extended time benefits are covered by your insurance, an extended time charge is applied every 15 minutes after a 30-minute return visit.
$60 for additional 15 minutes
$100 for additional 30 minutes.
Sliding Scale available for Medicaid, HCA Waiver required.
Waived with RMNW Concierge membership.
Naturopathic Medicine (In-Network)
Office Visits: Typically benefits available as copay/coinsurance/deductible.
Annual Exams: Typically benefits available if naturopathic benefits available.
Spinal Manipulation: Typically benefits available allotted under your chiropractic listed benefits, may be subject to co-insurance.
Trigger Point Injections: Typically benefits available as after deductible or co-insurance.
Biofeedback: Typically not covered, unless prior auth obtained for Migraine Treatment as only covered benefit we have seen in 10 years of practice, regular Non-covered fee of $125 applies for treatments for mental health, cardiovascular, pain management, or digestive health goals.
Acupuncture (In-Network)
Evaluation Codes*: 99202, 99203, 99213, 99212 are generally covered every 4-6 visits. If denied $30-75 non-covered cost is applied
Core Acupuncture procedure Codes: Benefits are generally provided up to 3 units for combination of 97810, 97811, 97813, 97814
EAMP / Cupping : Many insurances now are not covering this service, our out of pocket cost is $25 when bodywork, coaching, education, chinese medicine assessment is used in office.
*Not all conditions may be eligible for acupuncture, and if denied, will be subject to direct pricing, providers are trained to use the most specific code for the condition you are being treated for.
Naturopathic Medicine (In-Network)
Office Visits: Typically benefits available as copay/coinsurance/deductible.
Annual Exams: Typically benefits available if naturopathic benefits available.
Spinal Manipulation: Typically benefits available allotted under your chiropractic listed benefits, may be subject to co-insurance.
Trigger Point Injections: Typically benefits available as after deductible or co-insurance.
Biofeedback: May provide benefits for cardiovascular, migraines, mental health, or digestive health concerns. If denied direct pricing is applied.
*Some out of state Premera Blue Cross Plans may not provide Naturopathic Medicine Benefits
Acupuncture (in-network)
Evaluation Codes*: 99202, 99203, 99213, 99212 are generally covered every 4-6 visits. If denied $30-75 non-covered cost is applied
Core Acupuncture procedure Codes: Benefits are generally provided up to 3 units for combination of 97810, 97811, 97813, 97814
EAMP / Cupping : Many insurances now are not covering this service, our out of pocket cost is $25 when bodywork, coaching, education, chinese medicine assessment is used in office.
*Not all conditions may be eligible for acupuncture, and if denied, will be subject to direct pricing, providers are trained to use the most specific code for the condition you are being treated for.
Acupuncture (In-network)
Evaluation Codes*: 99202, 99203, 99213, 99212 are generally covered every 4-6 visits. If denied $30-75 non-covered cost is applied
Core Acupuncture procedure Codes: Benefits are generally provided up to 3 units for combination of 97810, 97811, 97813, 97814
EAMP / Cupping : Many insurances now are not covering this service, our out of pocket cost is $25 when bodywork, coaching, education, chinese medicine assessment is used in office.
*Not all conditions may be eligible for acupuncture, and if denied, will be subject to direct pricing, providers are trained to use the most specific code for the condition you are being treated for.
Naturopathic Medicine (In-Network)
Office Visits: Typically benefits available as copay/coinsurance/deductible.
Annual Exams: Typically benefits available if naturopathic benefits available.
Spinal Manipulation: Typically benefits available allotted under your chiropractic listed benefits, may be subject to co-insurance.
Trigger Point Injections: Typically benefits available as after deductible or co-insurance.
Biofeedback: Typically non-covered ,subject to $125 non-covered fee
Naturopathic Medicine (In-network)
Molina offers benefits for office visits, annual exams, and spinal manipulation care at our office. Most patients are subject to their PCP or Specialist based copay for services in office. Molina Marketplace Members, $25 admin fee applies to visits
Molina Apple Health Medicaid Members are no responsible for the $25 admin fee. However Molina Apple Health does not cover all services at our office, and subject to our 40% off sliding scale rate for any non-covered services.
Acupuncture (out of network)
Acupuncture is not covered under Apple Health /Molina Medicaid or the Marketplace plans at our office.
Marketplace Plans: We recommended using our new integrative concierage plan or package options for Acupuncture. $200 for initial visit, $150 for return visits.
Molina Apple Health: We offer reduced sliding scale rates of $150 initial and $100 for return Acupuncture visits.
Naturopathic Medicine (In-Network)
Office Visits Costs, annual exams are typically covered.
Spinal Manipulation care is a non-covered service with Cigna
Regular Admin Fee of $25 per 30 minutes applies to all visits
Spinal manipulation care is priced per region of the body.
Acupuncture (In-network)
Our Acupuncture providers are in-network with Cigna.
Cigna only provides benefits for Acupuncture insertion only, and does not cover the Evaluation portion of the visit: $50-75
Cigna members should note that after 6 visits, American Speciality Insurance the company that acts as an intermediary typically blocks acupuncture sessions after 6 visits requiring prior-authorization for continued visits. This may be denied by insurance, and may require you to pay for additional visits when not covered.
Naturopathic Medicine (Out of Network)
We are “out of network” for United Healthcare for our Naturopathic team, and can supply a superbill where needed for reimbursement. We have chosen to close our contract with United Healthcare due to failure to increase reimbursement for over 10 years.
Acupuncture (In-network)
Our Acupuncture team is “in-network” for United, and typically provides office visit benefits and direct acupuncture benefits. $25 Admin fee and $25 EAMP service fee still applies to any copay/coinsurance/deductible patient responsibility you may have.
Naturopathic Medicine (In-Network)
We are considered In-Network for Kaiser PPO.
Patients of Dr. Simon can use their Kaiser PPO Copay
Patients of Dr. Severson, Dr. FauntLeRoy, Dr. Hernandez use the First Choice Copay amount for billing Kaiser PPO plans.
May have limits on Spinal Manipulation
Biofeedback is non-covered
Acupuncture (In-network)
Dr. Phonexay Lala Simon is only provider in-network with Kaiser PPO at this time.
Kaiser PPO does not provide benefits for the evaluation portion of the visit, but does provide benefits typically for the primary acupuncture treatment.
Regular Admin fee ($25) and EAMP fee ($25) applies
Naturopathic Medicine (In-network)
The first Choice Health network often provides support for Kaiser PPO members to obtain care in private practice offices. All of our ND providers are in-network with first choice/first health.
Regular Admin Fee of $25 per 30 minutes visit applies.
Acupuncture (Out of Network)
Acupuncture services are typically out of network billing for purposes of aiding reimbursement. Many First Choice plans do support out of network coverage for care. We recommend calling your insurance company to determine benefits.
Naturopathic Medicine (In-Network)
Coordinated Care / Ambetter through health exchange provides basic coverage for office visits, annual exams, and spinal manipulation care only.
Regular Admin fee of $25 applies per each insurance based visit unless using membership option.
We are NOT in-network with Coordinated Care Apple Health plans
Acupuncture (In-Network)
Dr. Phonexay Lala Simon is the only provider currently accepting Coordinated Care through Ambetter. Coordinated Care Ambetter will provide support for initial evaluation visit, and acupuncture codes typically.
Regular $25 admin fee applies per each visit + any non-covered service such as the EAMP bodywork fee.
Direct Pay Fee Schedule
& Non-Covered Services
The following are the out-of-pocket costs associated with services at Rebel Med NW when insurance does not cover or provide benefits for the procedures. These direct pay options offer a 10% discount from the full fee. Please feel free to use these helpful worksheets to understand the fees associated with the services at Rebel Med NW.
Office Visits
Office Visits Costs if not covered by insurance: $120-350 based on time/complexity, Superbill available if you submit out of network for reimbursement.
Annual Exams
Annual Exam costs if not covered by insurance: $120-350 based on new vs established and age of patient per standard CPT coding. Superbill available if you submit out of network for reimbursement.
Prescription Medication Refill
When looking to refill your medications, please contact your pharmacy first and notify them of the need to refill. This electronic process is more efficient for our providers to confirm safety, appropriateness of medication, and if any additional care is needed.
When a RX is needing to be refilled that is new, has not been discussed before, or has been over 6 months since previous renewal, it may be subject to our non-office visit $50 fee for expedited refills, or we suggest setting up a telemedicine or office visit to discuss.
Extended time visits / Comprehensive Lab review Visits
When no extended time benefits covered by your insurance, an extended time charge is applied for every 15 minutes after a 30 minute return visit at $60 for 15 minutes and $100 for additional 30 minutes. Waived with RMNW Concierge membership.
No show Fee or Late cancelation - ND
$125 – The No Show/Late Cancellation fee is applied to cancellations made less than 24 hours in advance or the visit is No-Showed. This is to cover the loss for the provider because we did not have the time to fill the opening with another appointment. First No-show/Late Cancel will be a courtesy reminder and emergency events or illnesses are exempted, but please try to let us know as soon as possible so we can attempt to fill the space with the patients on our waiting List.
Acupuncture Evaluation / Chinese Herbal Medicine Consult
An initial evaluation to one of our Chinese Medicine practitioners, can typically be billed to insurance, however when not covered by insurance for a 99203 or 99204 it will be $50 or $75 respectfully in addition to additional procedures performed.
A follow-up evaluation performed for a new medical concern, or for additional management, education time, or counseling a 99213 or 99214 is used and will be $30 or $50 when no benefits provided by insurance.
Chinese Massage, Tua Na, Cupping Therapies
When your insurance company doesn’t provide benefits for 97140, manual therapy, we charge $25 per 15 minutes of manual therapy time, this can include time spent for Chinese massage, cupping, or body work performed by the practitioner.
Heat Therapies / Infrared / Moxibustion
When your insurance doesn’t provide benefits for the heat applications provided by Chinese medicine practitioners, we charge $5 for this service.
No show Fee or Late cancelation - Acupuncture
$75.00 – The No Show/Late Cancellation fee is applied to cancellations made less than 24 hours in advance or the visit is No-Showed. This is to cover the loss for the provider because we did not have the time to fill the opening with another appointment. First No-show/Late Cancel will be a courtesy reminder and emergency events or illnesses are exempted, but please try to let us know as soon as possible so we can attempt to fill the space with the patients on our waiting List.
Blood Draw Processing Fee
Blood Draw processing fees are as follows:
$20 – Standard blood draw fee for Typical annual or evaluation labs
$50 – Advanced testing panels for Food Allergy, Nutrition / Urine Panels.
Food Allergy Tests
Food Allergy tests are rarely covered by insurance, we have several options available that range from $209-$500. Non-covered Service waiver needed.
Functional Medicine Hormone, Digestive, & Nutrition Panels
We offer multiple options for in person or drop-shipped based nutritional, hormonal, or GI function panels that can provide comprehensive awareness of your health and current physiology. These panels have some variability in insurance coverage as you work with each lab. Due to the complex nature of these panels, we do charge a $100 interpretation fee for the time needed to customize care recommendations for your health, this is covered once per 6 months under the RMNW Concierge Membership.
Biofeedback Training
When not covered by your insurance, a $125 non-covered biofeedback service fee is applied in addition to any patient responsibility through their insurance for the 30 minute office visit portion of their 60 minute biofeedback training session.
Virtual Reality Exposure Therapy w/ Biofeedback
When not covered by your insurance, a $150 non-covered biofeedback service fee is applied in addition to any patient responsibility through their insurance for the 30 minute office visit portion of their 60 minute biofeedback training session.
Extended time Counseling Visits
When not covered by your insurance, an extended time charge is applied for every 15 minutes after a 30 minute return visit at $60 for 15 minutes and $100 for additional 30 minutes of counseling and health coaching support. Sliding scale available for apple health/medicaid clients. Waived with RMNW Concierge membership.
Massage Therapy
Massage therapy provided at Rebel Med NW uses the standard 97124 CPT coding, and when not covered by your insurance, our direct pricing rate for 60 minute scheduled massage is $150/ 60 minutes, $200/ 90 minutes, and $250/ 120 minutes.
No show Fee or Late cancelation - Massage
$100.00 – The No Show/Late Cancellation fee is applied to cancellations made less than 24 hours in advance or the visit is No-Showed. This is to cover the loss for the provider because we did not have the time to fill the opening with another appointment. First No-show/Late Cancel will be a courtesy reminder and emergency events or illnesses are exempted, but please try to let us know as soon as possible so we can attempt to fill the space with the patients on our waiting List.
Iron IV Infusion
We offer Iron IV Infusion, but is rarely covered by insurance for functional medicine benefit, and may only provide partial coverage for material and supply cost. We charge a direct pricing supply charge of $125/100mg for each Iron IV + additional patient responsibility per insurance guidance for copay or deductible for the process of infusion or any associated office visit performed.
Nutrient IV Therapy
This is a direct pricing service as listed on our Nutrient IV Therapy Page per each item listed, and is not a billable service to insurance.
Nutrient IM Injections
This is a direct pricing service as listed on our Nutrient Vitamin Injection Page per each item listed, and is not a billable service to insurance.
Cosmetic Acupuncture & Facial Bio-Injections
This is not a service that is billable to insurance at this time, and the pricing outlined is reviewed prior to having the service performed. We offer various package discounts & financing options through Care Credit if needed.
RF Microneedling with Potenza
This is not a service that is billable to insurance at this time, and the pricing outlined is reviewed prior to having the service performed. We offer various package discounts & financing options through Care Credit if needed.
Naturopathic Medicine
We apply a 50% sliding scale for Low Income / Medicaid services, and a 30% sliding scale for Military / Seniors for services that are considered medically necessary.
Office Visits: $75-$150
Physical medicine procedures: $30-80
Counseling/Biofeedback/VR Exposure therapy procedures: $50-100
Acupuncture
Our initial rate for Acupuncture is discounted by $50 for initial visits, and by $25 for return visits. (Initial $125 & Return $100)
Billing Policy Acknowledgment
If you cancel an appointment within 24 hours or do not show up to the appointment, you will be charged a cancelation fee of $75 on the card provided for registration of the appointment request.
Billing In-Network
Private or Public Health Insurance
While we make every effort to support billing your health insurance for your benefit, we have found as an integrative medical clinic, not all services will be deemed medically necessary by your health insurance carrier, either because they don’t offer benefits, or they have chosen to provide limited benefits for services. In some cases, an insurance company can remove a payment over a year later after it was initially paid because they will determine a service not to be covered.
In order to optimize your awareness of the cost of medical care, please do not hesitate to ask for clarification in order to support your financial health & well-being. Our pricing structure is here to benefit your awareness and allow our providers and support team to be paid a living wage in Seattle.
The following policies will apply if your insurance company denies services, or later removes coverage after initial payment for services:
- We will decrease the cost of the denied service to our direct pricing rate for that service. Typically 15% discount from the full fee submitted to insurance.
- We will offer a package rate if multiple of the same services are performed, and are later determined to be denied or benefits exhausted (acupuncture, massage, spinal manipulation, biofeedback)
- You will be informed prior to receiving a non-covered service of the direct pricing rate for that procedure. Not all insurance plans provide full comprehensive coverage for the providers’ full scope of practice.
Billing Out-Of-Network Health Insurance
Or No Naturopathic or Acupuncture Coverage
A superbill (invoiced list of services) will be provided to you along with a receipt for services, that can be used for reimbursement from your health insurance carrier if they offer out-of-network benefits, or for use with FSA/HSA-based funding.
Our services would be billed at our direct pricing rates, packages, or use of our concierge membership program.
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