FAQ: Insurance & Health Plans

Heck no!

No. Althera Alternative Care is a great way to receive high quality direct primary health care services, but we do believe insurance is necessary in case of severe illness, need for hospitalization or an unexpected event.

No. Althera Alternative Care does NOT yet contract with any private or public insurance plans.

Very unlikely. However, this type of practice is loosely termed “Direct Primary Care” and is mentioned briefly in the Affordable Care Act as “participating in insurance exchanges with a wrap-around insurance plan”. The details of such are still very unclear, but we are not waiting around for Washington or any other capitols to provide our community with high quality, affordable primary care. We keep abreast of all healthcare mandates and update our customer base on issues that directly affect our care or services we provide.

We do not contract with any Medicaid plans and cannot bill them for our services. Medicaid recipients are welcome to join Althera Alternative Care but will likely also be assigned a “network Primary Care Physician (PCP)” that may be required to access other health plan benefits and services.

We can contract with Medicare beneficiaries to provide stellar primary care services. Our charges cannot be billed to Medicare by us or the patient and the beneficiary must sign a Private Contract prior to joining acknowledging this fact. As Medicare is an open network, patients may continue to use their Medicare benefit elsewhere with accepting providers as usual.

In most cases, yes. Your insurance plans will continue to operate “as usual” at other practitioner’s offices, hospitals and pharmacies. PPO-style plans do not require a designated “gatekeeper” provider for referrals, medications, tests, etc. Althera

Alternative Care clinicians can order or refer just as another practitioner or doctor would do. HMO-style plans (including New Mexico Medicaid plans) do require an in-network designated primary care provider for access to other services, so these do not pair as well with Althera Alternative Care.

For the time being, insurance companies do NOT recognize our membership fees as a reimbursable expense. For non-covered service fees (meds, labs, x-rays, etc.), we can provide a receipt of payment so you can proceed with billing your insurance plan if you wish. However, most of our members have not found it worth the time and effort to do so.

Please contact us or an accounting professional to discuss this matter.

We are not financial or health insurance advisors and recommend you speak with a professional in that industry if you have questions. However, our members often find that high-deductible (or catastrophic) insurance plans pair well when combined with our services. Althera Alternative Care can provide day-to-day services and a high-deductible plan will be necessary to limit the enormous expenses of a major medical event.