September 15, 2002

Dear patient with Blue Cross insurance:

On December 11, 2002 my contract with Blue Cross will be terminated at my request. This summer, Blue Cross began a systematic delay in providing payment and down coding/discounting the services you received. They have asked to review nearly all of your medical records and as a result, they are recoding your 20-30 minute consultation to a visit that typically lasts a few minutes and is subsequently paid at below my overhead. With the down-coding, I am essentially paying for some of your visits. In addition, I am uncomfortable revealing some of the personal information that you have shared. To fight every claim is simply not reasonable or feasible. Because it is now jeopardizing the viability of my practice, your follow-up visits may be rescheduled until after the termination date. You will be called if your appointment needs to be rescheduled. I can not afford to provide you the time or the quality of care I believe you deserve with down-coded Blue Cross reimbursements.

The influence that these policies have on your visit has already affected the way I am caring for you. I am in the uncomfortable position of trying to second guess what they think is the minimum it will take to keep you from emergent disease. It is not what I am passionate about. My only concern, for which I took an oath, has been and will continue is to use whatever resources to provide what is best for you. I know that we share the belief that you choose my office for health care. I am not going to compromise you or myself.

This decision was not easy for us. We know it may place additional burdens on you, but it has to be done in order for you to get the time and care it takes to make a difference. For those with high deductibles, you may actually save money. Some policies are only administered by Blue Cross and do not actually have Blue Cross insurance; these may not be impacted at all. Most of you are seen only a few times in a year and so the change will hopefully be minimal. Do respect that providing care whether it be through e-mail, telephone, or in person takes time, economizing through deferred office visits has limits.

For those of you who continue with Blue Cross, I am going to be upfront now about how we will operate. Without exception, the visits must be paid in full at the time of service (a current fee schedule of common charges is listed below). Once you have paid, we will give you a superbill or HCFA insurance claim to submit to Blue Cross for re-imbursement. We will not justify to Blue Cross why I spent time with you, why I ordered what I thought you needed, why nutrition and lifestyle choices were chosen over medications, etc. The information you want them to have will be your responsibility. Too much time is being used on paperwork that has nothing to do with your health.

It is not clear how much Blue Cross will cover when you are seen here in a non-participating provider’s office. I hope that they will make it feasible for you. The whole insurance situation has become a frustrating and disappointing experience for both the consumer and the health care provider. Please do not ask us to what insurance plan to switch, your insurance broker or human resources personnel are better able to guide you in this regard. We continue to participate in Cigna, Blue Shield, CCN, First Health, and PacifiCare as of this writing.

We value you as a patient and want you to stay with our practice.

Jeremy E. Kaslow, M.D., F.A.C.P., F.A.C.A.A.I.

Initial Visit: $290.00

20” Follow-Up: $135.00 includes our specialized urinalysis and metabolic check

Nutritional ACG: $30.00 (see my web site for what this identifies…)

Lab Review: $20.00 (allows you to get results without an in-office consultation)

Phone Consult: $60-125.00

Physical Therapy: $125.00/hour

P.S. – Please note that my cell phone number for emergent after-hours calls is now 714-454-0514.