What services are provided as a part of our annual fee?
Complete annual routine, diagnostic, regardless of medical condition or necessity, preventive physical exam each year,additional office visits on a routine basis to follow up on annual exam health goals, 24/7 electronic communication connection with your physician to secure annual exam-based health guidance and support. In addition, purely because our practice patient panel size is reduced with this type of private direct medicine, you’ll find that our interactions (whether virtual or in-office) are unhurried by insurance plan restrictions and requirements. And you’ll also find, for the same reasons, that there is little or no waiting time for appointments.
Are you on the medical staff of a hospital?
Yes. We are on the medical staff of Honor Healthcare Shea. If you require hospitalization, we will make visits and coordinate your inpatient care working with physicians who are based at the hospital.
Do I still need insurance if I enroll with you?
Yes. Concierge medical practices do not take the place of general health insurance coverage. Our practice is a primary care medical practice, not a health insurance program. You are advised to continue your PPO, Medicare or other insurance program.
Will my insurance still be billed for my office visits?
If our practice is in-network with your insurance plan, we can also provide plan-covered healthcare services that may be submitted to your insurance plan for reimbursement, with co-payments and deductibles potentially applicable. At this time, our physicians are Medicare participatory but currently outside all private insurance plans.
Is there a co-payment?
Only if we are in-network with your plan (for now, we are only in-network with Medicare), and, only if we are delivering Medicare-covered healthcare services. Otherwise, no.
Are you a Participating Provider for Medicare?
Yes. We resumed Medicare participation to ensure we are able to continue to provide healthcare to our patients should the U.S. healthcare evolve into a Medicare-based system. And, additionally we want to resume Medicare participation so we can provide as requested or needed Medicare-covered services to our Medicare eligible without triggering additional fees or costs (other than potential co-payments or deductibles, which are lower costs than providing Medicare-covered services on a private fee basis as opted-out physicians). Separate from our private fee services, which are designed to be outside Medicare coverage, we can also provide Medicare-covered services to Medicare eligible (such as: virtual check-ins, Annual Wellness Visits, the Welcome To Medicare physical, chronic care management (CCM), care coordination, and telehealth services). And, with Medicare eligible, Medicare will of course continue to pay for services (i.e. lab work, x-rays, etc) that are ordered by us but provided by a different facility.
Do you bill Medicare or other insurance plans for the annual concierge fee?
No. Our private fee services are designed to be outside Medicare coverage and therefore lawfully delivered for private fees, so your private fees paid to our practice should never be submitted to Medicare for reimbursement. And, at this time we are outside of network on all private health insurance plans and do not participate with Medicaid reimbursement.
Will my private insurance reimburse my annual concierge fee?
Generally, no. But, some private health insurance plans may partially reimburse patients for a portion of the private fees allocated to an annual routine diagnostic exam—please contact our office to request a “super-bill” for the annual routine diagnostic exam. Private plans will not reimburse the private fees allocated to our health data communication platform.
I have a HSA account attached to my PPO health insurance plan. Or, I have a FSA or HRA healthcare expense reimbursement plan with my employer. Can I use HSA, FSA, or HRA funds to pay some or all of your private fees?
While we are not tax experts and do not give tax advice or guidance, we do believe that our diagnostic routine exam and related health data communication plan services both qualify as “medical expenses” such that those expenses are suitable for HSA, FSA or HRA reimbursement. Routine annual diagnostic exam expenses, and expenses connected to health data storage and communication platforms, are both identified as “medical expenses” in the annual IRS Publication 502 on what do and do not constitute “medical expenses” eligible for HSA, FSA and HRA funding. Patients are advised to consult their accountant or their human resources representative at their place of employment to inquire and confirm on FSA and HRA eligibility. And patients are advised to confer with their tax expert on HSA eligibility.
Is the annual concierge fee tax deductible?
The IRS has complex rules on when Americans can deduct their medical expenses. Because the test for this is in part based on the patient’s annual gross taxable income relative to level of medical expenses incurred, deductibility is rare and typically only applicable toward the end of life (when medical expenses may reach the necessary threshold as a percentage of gross income). Patients are advised to consult with their tax consultant to clarify qualification in their particular circumstance.
What about lab, x-ray, specialists’ fees and hospitalization?
Your annual fee pays for the specified private services: a combination of routine regardless of condition diagnostic exams and related communication/data services.. However, all other procedures and services not performed in our offices will be billed by the performing entity and should be covered by your insurance plan.
What do I do if I become ill while traveling or away on an extended vacation?
You would call 911 if you have a life-threatening emergency. Then call us. Call us first if the problem is minor. With the exception of a few controlled substances, most prescriptions can be ordered anywhere in the country. If you seek care at an emergency room or urgent care center out of our area, we will be readily available for phone consultation with you and/or other health care personnel. If you should require hospitalization while away, at your request, we will establish phone communication with you and your attending physician(s) to ensure continuity of care.
What if I need to see a specialist or a surgeon?
Of course, our patients are free to see any specialist they wish. We are available to help you decide what specialists to see and to coordinate such consultations. In this way the most appropriate resource is used, the earliest arrangements are made, and your applicable medical information is sent in advance of your specialist visit.
What about the cost of prescription medications?
The costs of prescription medications are the patients’ responsibility and in most cases should be covered by their insurance plans. We have expertise in assisting patients in purchasing medications in the most cost effective manner.
Will I be required to pay my annual concierge fee even if I do not use your services?
Yes. The private fees you pay are in exchange for our practice making available an array of routine diagnostic exams and related heath data communication services. Paying your concierge fee allows you to access those private fee services as a member of the practice whether you are sick or well. We cannot force patients to utilize all services made available, and tracking utilization each year would be difficult. We strongly encourage patients to fully avail themselves to all private fee services each year, but cannot effectively require utilization. We also strongly encourage patients to make at least one (1) office visit per year.