FAQ
Our healthcare system has become so complex that the very simplicity of the direct patient care model is what makes it hard to understand. If you have questions which are not addressed here, please contact our office. We would love to talk to you about this model and how it can benefit anyone.
I have Medicare. How can my membership actually save me money?
Many of my Medicare patients save more than the $66 they pay each month to be a member in the practice, particularly if they are healthy and do not typically have to see specialists. Consider the following. Medicare Part B is voluntary, not required. Only Part A is required. You can keep the amount you pay each month for your supplement, see me for most of your healthcare needs, and if you need to see a specialist or have diagnostic studies, you just pay the 20% out of pocket. Considering most supplements cost $2400 to $3600 per year, you will likely come out ahead. Part A covers you if you are hospitalized. For those who feel better having a supplement, you can choose a Plan F high deductible supplement. The premium is often less than $100 per month, and you pay the first $2160 as a deductible if you have to use it. Have a good year and you saved more than the $792 you pay to be a member. Have a bad year and you just pay the $2160 that you would have paid for the higher premium supplement anyway. You have nothing to lose; only savings to be gained.
I usually only see the doctor once or twice a year. Why can't I just pay cash when a visit is needed?
The direct care model works to keep the costs down for everyone because everyone is paying every month. This allows the total membership to stay relatively low, which allows for the accessibility, long appointments, and no waiting. Cash fee-for-service results in volume-driven reimbursement, just like traditional practice. When revenue is no longer dependent on high volume, the volume stays low and access remains high. Simply put, the direct care model just doesn't work that way.
I have insurance. Why should I pay you a monthly membership fee?
That is one of our favorite questions. As more and more people are discovering each year, especially under Affordable Care Act plans, having insurance and having access to care are completely different. You are paying for the personalized service that is not available in fee-for-service practices, at a fraction of the cost of concierge practices.
What happens when I need labs or xrays, or if I need to go to an ER, specialist or hospital?
Since direct patient care is not an insurance plan, you still need to carry insurance that covers you if you have a high-cost health event or need expensive tests. Whenever you need labs or xrays, or if you have to go to an ER, specialist or hospital, you would use your insurance for those items. If you don't have insurance, I can help guide you to the services that are least expensive; there are very affordable options for labs and xrays for those who have no insurance. And your access to me can help ensure that you do not need costly urgent care visits. I also have the time to discuss your care with specialists, and sometimes this can preclude the need to visit the specialist or have an expensive imaging study.
What if I have Medicare? Since Dr Vicencio is "opted out" of Medicare, how does that affect when I need to use my Medicare for other services?
My opting out of Medicare has no effect on your Medicare coverage for all other providers who accept Medicare reimbursement. It is necessary for me to opt-out of Medicare so that I can have a private, monthly fee-based arrangement with you. In fact, Medicare is the ideal complement to a direct patient care practice because you are covered for everything else outside of my services. I am approved to order labs, x-rays, home health services, DME, etc. for all Medicare patients; I just don't bill Medicare myself.
What if I have a flexible spending account (FSA) or a healthcare spending account (HSA)? Can I use it to pay the monthly fee?
The tax laws regarding the use of FSA and HSA cards are evolving. You can't use an HSA to pay insurance premiums; prior to the Affordable Care Act, the monthly fee in a direct patient care practice was viewed in a similar way as an insurance premium. The ACA specified that direct primary care docs are not insurance companies, but the tax laws are evolving more slowly. So, you should consult with your accountant before using an FSA or HSA card to pay the monthly fee as the tax laws surrounding their use are expected to change in the near future. We will provide a detailed receipt that outlines the services rendered for the monthly fee in order to facilitate the use of FSA/HSA funds; however, it is your responsibility to make sure you are using these tax-advantaged accounts appropriately.
If I already have a comprehensive insurance plan (PPO/HMO), what happens if I need to get prior approval for medications, x-rays, or specialty services?
I am happy to get prior approval for any medications or diagnostic studies your insurance requires. However, I am not an in-network physician on any insurance plans, so if your plan is an HMO that requires authorizations to be done only by in-network physicians, I would not be able to do this and you would need to see the primary care doctor to whom you were assigned, and pay the office visit copay, in order to get an authorization. I am not aware that any insurance plans require that medications be prescribed by an in-network physician in order to cover them, but if you have an HMO you should be sure to verify that. Plan requirements change every year.
What happens with immunizations? Especially for my children?
Immunizations are not included as part of the monthly fee. All of the common adult immunizations are now offered at most local pharmacies and I would provide a prescription in order to have that done at the pharmacy. Some pediatric immunizations are now given at the pharmacy; the remainder are given at the local health department.