Redefining Pediatric Medicine: Why GetzWell Pediatrics’ Unique Approach Requires Us To Be Out-of-Network

GetzWell’s mission is based on the conviction that parents and trained health care professionals, not the insurance companies, should decide how kids are cared for. This is why we are ‘out-of-network.’

Since its inception, San Francisco’s GetzWell Pediatrics has sought to redefine the field of pediatric medicine by providing customized health care for children and families. Some wonder why GetzWell is structured as a ‘fee-for-service’ or ‘direct pay’ practice rather than one that contracts with insurance companies. The reason is that GetzWell’s 21st century integrative approach to health care is fundamentally at odds with the traditional insurance-based medical model.

In the traditional model, insurance companies set prices for physician services that encourage a rapid turnover, high volume practice. An insurer might set a price for a 5-7 minute visit at $35, for instance, but only pay $50 for 15 minutes or $70 for 30 minutes of care. In order to cover the exorbitant overhead that accompanies an insurance-based practice (including an entire staff of billing specialists and collection agents), physicians must see as many patients per hour as possible to make their practices viable. This turnstile approach has led to a ‘quick fix’ culture in medicine and discourages the development of meaningful relationships between families and their care providers. GetzWell Pediatrics categorically rejects this system as it isn’t the best way to care for kids (or anyone, for that matter).

Moreover, just because GetzWell is fee-for-service does not mean patients cannot use their insurance. In fact, most patients with PPO insurance receive some, often significant, reimbursement (subject to the specific terms of each policy). It is a very easy process to seek reimbursement or credit from insurers following office visits. Each time a patient receives care, GetzWell generates a ‘superbill‘ reflecting payment along with a description of services. By simply mailing or faxing the superbill directly to the insurer, most families report they are reimbursed or otherwise credited within 4 weeks (based on the specific terms of their policy).

By remaining ‘out of network,’ GetzWell’s pediatricians and patients collaborate to make important health care decisions without interference from insurance companies. Insurers are relegated to a still important but secondary role whereby they cover some primary care costs plus emergencies, severe illness and catastrophic matters. As a result, the quality of care at GetzWell is unsurpassed and many unique services are available including:

  • Individually tailored well-child visits and care plans to fit the needs and lifestyles of patients by focusing on the underlying causes of illness and health and not merely suppressing symptoms
  • Guidance about safe vaccination for kids and individualized vaccine schedules based on each child’s risk factors and the family’s beliefs and lifestyle;
  • 24/7 direct access to GetzWell pediatricians by phone and email
  • More time spent per visit in order to answer questions, get to know parents and children, foster trusting relationships, provide education and discuss options as part of a holistic pediatrics plan of care (e.g., a typical well child visit lasts 40 – 45 minutes in contrast to about 12 minutes in a traditional pediatric practice)
  • Options outside of typical prescription medications including food and lifestyle interventions, homeopathy, supplements, developmental/emotional advice, and stress management for children from programs like StressWell.
  • A combination of Western medicine and complementary and alternative approaches to illnesses or chronic problems that cannot be “fixed” by typical 20th Century approaches
  • A collaborative team comprised of board certified pediatricians plus an experienced certified lactation consultant, a pediatric nurse practitioner with a specialty in children’s development, and a psychotherapist with a focus on families and mothers (because transitioning to parenthood is one of life’s toughest yet most rewarding challenges!).
  • At GetzWell, we love what we do and this is reflected in the warmth with which families are greeted upon entering the office, the undivided attention patients receive at every visit, the unparalleled access to doctors and, most importantly, the result—having a child who is unusually healthy, seldom or never requiring antibiotics or other prescription medications. We value each patient, family and interaction and cherish the opportunity to practice medicine in a way that’s consistent with our deepest principles and beliefs.

If you are in the San Francisco area, please call us at 415.826.1701 or contact us online to schedule an appointment. We look forward to meeting you!

GetzWell Pediatrics         1701 Church Street          San Francisco,  CA      94131

Want to know more?

We are committed to providing the best pediatric care in the Bay Area. If you want to learn more about our practice, please contact us.