Why Direct Pay — and why it’s better for your child.

What is Direct Pay?

Direct pay means we work directly for you—not your insurance company. Instead of billing insurance, we collect payment before each visit or procedure. This allows us to provide more time, better access, and care that’s built around your family—not insurance paperwork.

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The Insurance-Based Model

In the majority of medical practices, doctors are reimbursed by insurance companies after the visit based on negotiated rates for visits and procedures.. But here’s the catch:

Insurance pays for E/M and CPT codes — not quality of care
Insurance may reimburse slightly more for longer visits—but not enough to make up for the time lost seeing other patients.

Understandably, this creates pressure to see as many patients as possible, as quickly as possible. Even for complex concerns like seizures, developmental delays, or ADHD, doctors may only have 15–20 minutes to listen, assess, explain, and document—before rushing into the next room.

In addition, most insurance companies place big limits on reimbursement for telehealth visits, so doctors are less likely to make use of them—even when they can be highly convenient and effective.

This model leads to:

• Rushed visits that don’t leave space for questions
• Long delays just to get on the schedule
• Poor follow-up and slow response times
• High staff turnover, which makes it harder to build trust
• Limited telehealth, communication, or coordination outside of visits
• Overuse of billable procedures

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The system isn’t broken because doctors don’t care, most care deeply—it’s broken because insurance incentives don’t support the kind of thoughtful, long-term care most families need.

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How Direct Pay Makes a Difference

Our clinic is designed to serve a smaller number of patients more deeply—not to move as many people through the schedule as possible.

Here’s what that looks like:

• Longer appointments.
  We take the time to listen, explain, and make a plan that makes sense.
• Same-week scheduling.
  Most new families can get in within days, not months.
• Direct communication.
  You’ll speak with someone who knows your child—not a portal or call center.
• Follow-through that doesn’t fall through.
  Refills, forms, and calls don’t sit in a queue—we handle them promptly.

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Can I Still Use Insurance?

Understanding Out-of-Network Reimbursement

While we don’t bill insurance directly, many insurance plans will still cover most of the visit costs.

We do accept HSA and FSA funds and provide a detailed, coded “superbill” after every visit, which can be submitted to insurance for reimbursement for an out-of-network visit. Reimbursement amounts may vary depending on the specific insurance plan.

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Is Direct Pay Right for You?

We know this model isn’t for everyone. But for many families, it’s a welcome alternative to waiting months for a rushed visit and then struggling to get a follow-up question answered.

If you value:

• Time to ask questions
• A doctor who listens and follows through
• Getting answers without long delays

Then Orchard Park may be the right fit.