FAMILY MEDICINE

Do I need medical insurance if i join your plan?

I recommend that you carry health insurance to provide coverage for services not performed in my office.  Your annual fee will allow me to perform medical, laboratory or x-ray services in my office at no additional cost.  Outside of my office, you will still be responsible for charges incurred, such as:  hospital bills, prescriptions, consultations with specialists, CAT or MRI scans, as well as tests performed at other laboratories.  I suggest that you discuss your coverage needs with your insurance provider.  You may require only major medical coverage or be able to buy lower cost, higher deductible insurance than you currently carry.


My insurance currently covers doctors fees. Why cant I use it at your office?

My vision is a care system supported by my own patients and committed to extraordinary care and service.  The rates at which most insurance companies currently reimburse physicians for their services prevent me from providing you the high level of care and service I envision.


I am in a managed care plan. Can I still join your plan?

Yes.  Your annual fee ensures you access to care from me regardless of your insurance plan.  However, you should know that your managed care company, or your health maintenance organization (HMO), may refuse to pay for any services or prescriptions that are not ordered by one of their physicians.


What kind of insurance will work best with your new with plan?

Traditional fee-for-service plans, even if part of a preferred provider organization (PPO), will allow me to coordinate your care best.  They also permit you to make appointments with specialists yourself, should you desire.  Unlike managed care plans and some point-of-service plans, they do not require that your primary care physician be from their network.


If I go to an emergency room on the weekend, or see another doctor, will you pay my bill?

No.  Your annual fee ensures you access to care at my office during regular office hours.  I will always be available for emergency phone calls and to act as your advisor.  There may be times when we agree that an emergency room visit is necessary.  You are responsible for any charges incurred for services not provided by me.


Do I still have to pay your annual fee if I am on medicare?

Yes, you will be required to pay my annual fee.  However, Medicare should still pay for medical services obtained outside my office.


Can I join your plan later?

Maybe.  I believe that in order to provide the individualized, high-quality medical care that I have promised you, I need to limit the number of patients enrolled.


What are my options if I want to continue as your patient, but I simply cant afford the cost?

Although I have done my best to make this plan affordable, I realize that there will be some of you who will be unable to afford my annual fee.  I have established criteria for discounted participation in my clinic.  If you would like to be considered for discounted care, please note this on your application and someone from my office will contact you.


Is the annual fee tax deductible?

Although your insurance company probably will not reimburse you for your annual payment, you still may be able to write off a portion of your payment on your income taxes.  In addition, if your company has a Flex (Section 125) Plan or a HSA (Health Savings Account), you should be able to receive reimbursement for your annual payment with “before tax dollars.”  I encourage you to talk with your tax advisor and employer about these options.


Will I receive a discount if I don't have my annual physical exam or use all of your services?

No. Your annual fee covers my availability for complete supervision of your medical care.  I encourage each of my patients to see me on a regular basis.  Preventive care is the best foundation for an excellent quality of life.


If I become ill and require extensive medical services, will my bill increase?

Never.  It would be unthinkable to penalize you financially for illness.


Since I need to keep my insurance, will there be any problem with reimbursement for outside tests ordered?

I don’t anticipate this to be a problem.  Most of you are in medical plans in which “out of network” providers are allowed to order tests and provide hospital care.  On the other hand, a few of you are in managed care plans which almost certainly will refuse to pay for any test I order.  You may be required to get permission for these tests from your assigned “gatekeeper.”  For this reason, I recommend you re-evaluate the kind of insurance you have.  However, regardless of your coverage I will make every effort to get you the best care your insurance will allow.


Is the cost of prescriptions covered or discounted through my annual fee?

No.  But, as always, I will attempt to provide you with free samples whenever possible or with information to financially assist you in paying for your medications.


If I need to be hospitalized, where will I go?

I will continue to be affiliated with Seton Hospital and the Heart Hospital of Austin.


What happens if I move after i join?

If you must transfer your care, I will assist you with finding a new physician.  Your medical records will be sent promptly upon your  release of information.  The balance of your yearly fee will be prorated and refunded.


If I get married or have/adopt a child can I extend coverage to my new family members?

Children over 2, spouses and partners can be added as long as there is space available in my practice.


Can I still see my gynecologist?

Yes.  I am well trained and extremely experienced in routine, outpatient gynecological care, but I recognize that many women prefer to see a gynecologist separately.  As always, I will support and facilitate whatever decision works best for you.

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