Does this look like your last doctor’s
I have a high deductible major medical insurance plan or right now I am not covered by insurance, is becoming a “LAM” a good expense for me?
Answer: WE THINK SO!!! Having a relationship with PCC should help you make better choices in spending your health care dollars. Just look at the out of pocket expense of going to a traditional “insurance driven” primary care practice, or for that matter an urgent care center or emergency room. More importantly, more time is allowed for your attention with this model.
- Why have you decided to not take insurance or Medicare?
- Answer: There are many excellent primary care physicians available in “the system.” It is our opinion that it really comes down to the old “time and money” line. In the “insurance driven” primary care provider services” model, to maintain an anticipated income with declining fees primary care physicians are trying to see more and more patients per day. All office visits result in more “work” then the encounter itself (record keeping, etc.) and more costs that tend to be under appreciated. This scenario has a constant negative “pressure” to health care satisfaction for everyone, patient and doctor alike and ultimately healthcare quality.
- At Primary Care Consultants our answer to this issue is simple. We will avoid this “negative pressure” by not playing the insurance game. We will have membership fee included with your annual exam and a simple fee for service schedule that covers our anticipated needs, allowing plenty of time to be with the patient, not the paperwork. We will strive to avoid the “overbooked” scenario so common in primary care medicine.
- We also feel strongly that the “traditional insurance model” puts the physician in situations that are not always in the best interest of the patient.
- Lastly, we advocate that insurance should not be playing the role it does, in today’s market, in paying for basic primary care provider services. It is our opinion, that in many instances of primary care provider services, insurance actually reduces the incentive for provider and patient to consider costs and increases the overall cost of health care. Insurance should, in our opinion, be for major medical needs.
Will becoming a “LAM” of Primary Care Consultants P.C. take care of all of my health care needs and costs?
- Answer: No! and No! Most costs for health care are not provider charge related. PCC will attempt to offer excellent quality primary care services. It cannot however meet all health care needs. Example: If a “LAM” has a severe laceration the clinician may feel it is in the best interest of the patient to not repair the wound at PCC and refer the patient elsewhere. Another example would be a patient with chest pain indicative of a heart attack would need to be cared for at the hospital. Again, such referrals would not be covered by the PCC fees.
Is this a “boutique medicine” or “concierge” practice?
- Answer: NO! Not in our opinion. Primary Care Consultants is an attempt to return to a simple cash model primary care doctor that allows the doctor more time to develop a therapeutic relationship with each patient.
- If you investigate “boutique medicine” or “concierge” practices in the area you will see much higher membership fees. Our goal is quality Family Practice medicine in a non-harried environment.
Why “by appointment only”? What if I need to see you right away?
- Answer: We request that all patients call, or e-mail any appointment request (and receive confirmation from us regarding any such request) before arriving at the office. This will ensure that you get full attention for your needs.
- Please understand that time for same day appointments for sick visits are allowed for in the schedule. So if you wake up sick or are injured please call! We will get you in! But call first!
Why is the “limited access fee” necessary?
- Answer: It reflects your annual exam cost and establishes who actually wants to be a member of the practice and provides a necessary cash flow to cover base costs.
What happens if I get sick and the doctor is out of town?
- Answer: The doctor will arrange for Limited Access Members to have telephone coverage either by himself or another clinician when he is out of town. If, in the judgment of the clinician on call, the patient requires attention that cannot wait until the office reopens then the patient will be referred to an urgent care facility or to an emergency room. (Note: physician care and any other costs at these facilities are NOT covered by fees you have paid to Primary Care Consultants, P.C.).
Why is it called Limited Access Membership (LAM)?
- Answer: Because that is what it is! No physician can be all things to all people, nor can he/she provide quality care if working “24/7” 365 days a year. The term Limited Access Membership is used purposefully to highlight to members that this is principally a commitment to provide an annual physical exam and cognitive primary care services for outpatient care for a period of one year.
Will my insurance cover the fees of Primary Care Consultants, P.C.?
- Answer: It depends. Some plans will directly reimburse a member all or a portion of the charges for seeing a “non participating provider” for care. You have to read your policy. Medicare will not reimburse any charges.
Can I use money from a “health flex spending account” set up through my employer to pay for Primary Care Consultants, P.C. fees?
- Answer: Generally, yes. Please consult the plan and seek any tax advice you deem necessary from your accountant or other qualified adviser.
I have a major medical plan. Will lab tests, X-ray and diagnostic tests be covered if Primary Care Consultants, P.C. writes the orders?
- Answer: Generally, yes, but the insurance policy determines coverage. Every effort will be made to send you to a facility that accepts your insurance. Medicare patients will also have Medicare coverage for any tests if done at a Medicare participating facility (i.e. Saint Mary’s Hospital).
What if I have to go to a “participating provider” to have a test ordered?
- Answer: Though rare, in such an instance you would be given a letter documenting why Primary Care Consultants, P.C. felt the test was necessary, for you to take to an “in network provider” to order the test (note: the cost associated with seeing a “in network provider” for such a visit would be yours and is not covered by the fees charged by Primary Care Consultants).
Why do I have to sign a “Limited Membership Agreement”
- Answer: We live in a lawyer’s world! There have to be clear boundaries.
- The agreement serves to protect the Primary Care Consultants, P.C. and its physician from unrealistic member expectations.
- Yet remember, ultimately, the member is in control because he or she can always “fire” the doctor. Our goal is for that to never to be the case.
What do I have to do to show financial hardship?
- Answer: Present the physician with a letter of explanation regarding your situation. Proof of limited financial resources (income tax return, Medicaid status, etc.) may be required.
- What if I need to see the doctor for a sick visit or need a medicine refill right now?
- Answer: You first have to sign a LAM agreement, pay your LAM-CE fee and schedule a CE.
I would like to meet with the physician and ask some questions about the LAM contract before I sign up. Can I do that?
- Answer: Yes, brief 10 minute appointments can be scheduled for this (call 804-282-3495). Please understand that this can not be used for medical evaluation and treatment, nor serve as a means to establish a relationship with the Physician or PCC.
How do I sign up?
- Answer: Call 804-282-3495 to schedule a time to come by the office and sign a LAM agreement, pay your LAM-CE fee, and schedule an appointment.
Do you take credit cards?
- Answer: We accept Visa and Mastercard.