For all billing questions, please call: 877-599-7639 ext. 4213
Dear Valued Patient,
We have appreciated the trust you have placed in us over the years to take care of your sleep health needs. It is a responsibility that we take very seriously. Unfortunately, over the years, declining insurance reimbursements and rising costs as well as increased unpaid responsibilities (insurance appeals and administrative burden, prior authorizations, required forms and paperwork) have made providing superior care impossible within the current system.
While we have worked hard to make it work, it has reached a place within our practice that we can no longer afford to deliver the care we expect of ourselves and stay beholden to medical insurance services. I suspect that many of you have felt this change...longer waits for returned phone calls, less access to your clinicians, delays in order processing. This is a direct result of our inability to afford paying for more administrative help in the current medical system.
While it was not our intention to make this transition so suddenly, at the beginning of 2023, we were informed by several insurance carriers (Anthem, Optima, Aetna) that we are no longer considered in-network. This means that we will no longer be submitting insurance claims on behalf of you to your insurance as we no longer have a relationship with these payers. You will pay for the visit at the time of the service, and we will provide you what you need to bill your insurance if you choose to do so. Some insurances will reimburse for the contractual adjustment and refund you that amount, others may not.
While we think that ultimately this change will benefit everyone involved, we certainly understand if you need to seek care with a provider that participates with your insurance plan. We are fortunate to practice in an area literally bookended by both the Sentara Hospital sleep providers as well as those at the University of Virginia.
We will also happily offer a walk out statement for you to submit claims yourself.
You can definitely continue to receive your care at our office. If you have out of network benefits, we will be happy to supply you with the proper documentation for you to file your claims to your insurance. This will mean that if you are due any benefits, the insurance company will pay you directly. You will be required to pay my office directly, at the time of service for your visits. We will have several options to do so and will make every effort to minimize the strain of us no longer accepting insurance.
We hope that the experience you’ve had with us will encourage you to remain with our practice. Please know that we remain deeply committed to you and your sleep health. We’re happy to answer any questions you have regarding our change in healthcare insurance coverage.
Sincerely,
Chris Winter
We have appreciated the trust you have placed in us over the years to take care of your sleep health needs. It is a responsibility that we take very seriously. Unfortunately, over the years, declining insurance reimbursements and rising costs as well as increased unpaid responsibilities (insurance appeals and administrative burden, prior authorizations, required forms and paperwork) have made providing superior care impossible within the current system.
While we have worked hard to make it work, it has reached a place within our practice that we can no longer afford to deliver the care we expect of ourselves and stay beholden to medical insurance services. I suspect that many of you have felt this change...longer waits for returned phone calls, less access to your clinicians, delays in order processing. This is a direct result of our inability to afford paying for more administrative help in the current medical system.
While it was not our intention to make this transition so suddenly, at the beginning of 2023, we were informed by several insurance carriers (Anthem, Optima, Aetna) that we are no longer considered in-network. This means that we will no longer be submitting insurance claims on behalf of you to your insurance as we no longer have a relationship with these payers. You will pay for the visit at the time of the service, and we will provide you what you need to bill your insurance if you choose to do so. Some insurances will reimburse for the contractual adjustment and refund you that amount, others may not.
While we think that ultimately this change will benefit everyone involved, we certainly understand if you need to seek care with a provider that participates with your insurance plan. We are fortunate to practice in an area literally bookended by both the Sentara Hospital sleep providers as well as those at the University of Virginia.
We will also happily offer a walk out statement for you to submit claims yourself.
You can definitely continue to receive your care at our office. If you have out of network benefits, we will be happy to supply you with the proper documentation for you to file your claims to your insurance. This will mean that if you are due any benefits, the insurance company will pay you directly. You will be required to pay my office directly, at the time of service for your visits. We will have several options to do so and will make every effort to minimize the strain of us no longer accepting insurance.
We hope that the experience you’ve had with us will encourage you to remain with our practice. Please know that we remain deeply committed to you and your sleep health. We’re happy to answer any questions you have regarding our change in healthcare insurance coverage.
Sincerely,
Chris Winter
Visit Type Dr. Chris Winter Ellen Wermter, NP, DBSM
In Office: New $250
In Office: Follow-up $120
In Office: Follow-up (extended, >25m) $180
In Office: Simple Re-establish/Complex $120/$180
Telehealth: New $250 $250
Telehealth: Follow-up $120 $120
Telehealth: Simple Re-establish/Complex $120/$180 $120/$180
Telehealth: Follow-up (extended, >25m) $180 $180
Sleep Study Interpretation (Home sleep test, PSG) $275
Sleep Study Interpretation (MSLT) $125
Updated 1/20/2023. These prices are tentative and subject to change as we get our new processes in place. We will keep this page updated with any changes.
In Office: New $250
In Office: Follow-up $120
In Office: Follow-up (extended, >25m) $180
In Office: Simple Re-establish/Complex $120/$180
Telehealth: New $250 $250
Telehealth: Follow-up $120 $120
Telehealth: Simple Re-establish/Complex $120/$180 $120/$180
Telehealth: Follow-up (extended, >25m) $180 $180
Sleep Study Interpretation (Home sleep test, PSG) $275
Sleep Study Interpretation (MSLT) $125
Updated 1/20/2023. These prices are tentative and subject to change as we get our new processes in place. We will keep this page updated with any changes.
Frequestly Asked Questions
"Will this change affect my prescription/medication coverage?"
No. That is a relationship between your insurance and the pharmacy. It has nothing to do with our insurance participation. We will continue to refill your prescriptions as normal.
"Will this change affect the coverage of my sleep study?"
No. That is a relationship between your insurance and the sleep center, typically the Sentara Martha Jefferson Sleep Center. The only change would be that my interpretation of the study would cost $275. We will give you the necessary information to file this charge with your insurance.
"I have Medicare. Are you accepting Medicare?"
Yes, as of now we are still participating with most Medicare policies. We do not accept Humana Medicare Advantage/Plus."
"I'm an established patient in your clinic and I see you once or twice a year. What's changing?"
Probably little. The care you receive will be unchanged, if not enhanced by the process. You will pay for the visit at the time of service as per the fee schedule. You will have access to paperwork/superbill that will allow you to file with your insurance to cover the service if you choose to do so.
For our patients, that have a copay, you will not pay that copay to us. So, if you have a $40 copay, you will pay, on average, $80 more for the follow-up out of pocket. If you see us twice a year, you could potentially pay $240 for the year instead of $80. We believe that the care you will receive from us is going to be worth it in the long run and most importantly, allow us the capacity to provide you better service and spend more time with you in the future.
In the future, we will most likely establish very short medication or CPAP follow-up visits. If you currently have an $80 copay, and you are scheduled for a $60 15-minute medication/CPAP check slot, you would actually save $20 for the visit.
"The letter I received from my insurance company implies that I have to find an alternative provider for my care? Is this true."
No. It is your right as a patient to receive care from any provider you choose. While the service coverage may change (or not be covered at all), it is still your right as a patient to make the best medical decision as it pertains to you. We want you to remain in our clinic and we feel ultimately you will be happy with the choice. We understand if this is not the decision you want to make. It's important to us that you make the decision, and not an insurance company.
No. That is a relationship between your insurance and the pharmacy. It has nothing to do with our insurance participation. We will continue to refill your prescriptions as normal.
"Will this change affect the coverage of my sleep study?"
No. That is a relationship between your insurance and the sleep center, typically the Sentara Martha Jefferson Sleep Center. The only change would be that my interpretation of the study would cost $275. We will give you the necessary information to file this charge with your insurance.
"I have Medicare. Are you accepting Medicare?"
Yes, as of now we are still participating with most Medicare policies. We do not accept Humana Medicare Advantage/Plus."
"I'm an established patient in your clinic and I see you once or twice a year. What's changing?"
Probably little. The care you receive will be unchanged, if not enhanced by the process. You will pay for the visit at the time of service as per the fee schedule. You will have access to paperwork/superbill that will allow you to file with your insurance to cover the service if you choose to do so.
For our patients, that have a copay, you will not pay that copay to us. So, if you have a $40 copay, you will pay, on average, $80 more for the follow-up out of pocket. If you see us twice a year, you could potentially pay $240 for the year instead of $80. We believe that the care you will receive from us is going to be worth it in the long run and most importantly, allow us the capacity to provide you better service and spend more time with you in the future.
In the future, we will most likely establish very short medication or CPAP follow-up visits. If you currently have an $80 copay, and you are scheduled for a $60 15-minute medication/CPAP check slot, you would actually save $20 for the visit.
"The letter I received from my insurance company implies that I have to find an alternative provider for my care? Is this true."
No. It is your right as a patient to receive care from any provider you choose. While the service coverage may change (or not be covered at all), it is still your right as a patient to make the best medical decision as it pertains to you. We want you to remain in our clinic and we feel ultimately you will be happy with the choice. We understand if this is not the decision you want to make. It's important to us that you make the decision, and not an insurance company.
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Dr. Winter is board-certified by the American Board of Sleep Medicine and formerly by the American Board of Psychiatry and Neurology (he voluntarily elected to not renew this board because of their policies and fees). He is separately board-certified by the American Board of Psychiatry and Neurology (under the American Board of Medical Specialties) as a sleep medicine subspecialist. He is a member in good standing of the American Academy of Sleep Medicine the Sleep Research Society, and the Virginia Academy of Sleep Medicine.
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Charlottesville Neurology and Sleep Medicine 1410 Rolkin Court, Suite 101 Charlottesville, VA 22911 Secure email: https://sendsafe.to/cvilleneurosleep@gmail.com Regular email: cvilleneurosleep@gmail.com (434) 293-9149 (main) (434) 293-9140 (fax) (877) 599-7639 ext. 4213 (billing) |