I went into medicine to take care of people. Insurance regulations and Medicare laws were interfering with my ability to do this. Filling out paperwork and trying to keep up with all the bureaucratic rules were taking too much time from my time with my patients. I would rather work directly for my patients than any insurance company or bureaucrat.
How does this work?
I will provide you with personalized medical care, and you will pay for those services We will post our prices so that you know what to expect to pay.
How is this good for patients?
By taking the insurance companies and the government out of the doctor/patient relationship, the doctor works for you. You can rest assured that the choices we make for you about your care are not influenced by your insurance company or any other organization that could gain from you not getting what you need. We will be able to respond to your needs, not the demands of the insurance companies.
We work for the benefit of the patient, not the stock holders of an insurance conglomerate. Your care can never be rationed if you are paying for it yourself.
For which patients will this work best?
This type of medical practice will benefit many different types of patients. Patients who have no insurance or patients who have high deductibles will probably spend much less money for medical care in this office. Patients who have PPOs (Preferred Provider Organization) who do not need referrals for care may or may not spend slightly more for care with us, we are confident that the level of service will more than make up for the financial cost. Patients with government insurance (Medicare/Tricare) will pay more. Again, we are sure that the service we offer will be worth it for most people. For patients who have HMOs with strict network restrictions, this may be a more difficult proposition if they require you to be seen by a doctor in the insurance company’s network to get referrals. The same is true for MaineCare patients because they require a doctor to accept MaineCare in order for them to refer patients to specialists.
Can I get reimbursed by the insurance company?
That depends on your insurance company. We will be happy to provide you with a receipt and paperwork to submit it to them. You should check with your individual insurance company to find out.
Can I get reimbursed from Medicare?
The government has very strict rules about this. If a doctor has “opted out” of Medicare, he/she cannot submit bills to them for at least 2 years. Medicare patients must sign an acknowledgement of this, with the understanding that they are forbidden from asking for reimbursement for our office visits. This contract must be renewed every 2 years, unless the doctor agrees to start taking Medicare again. These rules apply only to services performed in our office.
I have Medicare; can you refer me to specialists? What about labs, X-rays, medicines and other supplies?
We can still refer you to specialists who take Medicare. We can also order medical services and supplies from vendors who accept Medicare (for oxygen, visiting nurses, physical therapy, medical equipment, etc.)
We can order X-Rays, CT scans, MRIs, and other procedures, which are done outside our office. These should be covered under your insurance just like it always had been. The facility doing the test will bill your insurance company.
Labs that we draw in our office that we send to an outside lab (cholesterol panels, liver and kidney functions, thyroid tests, blood counts, etc.) will also be covered by your insurance as before.
Services that we provide in the office, such as EKGs, breathing tests, urine tests and finger prick blood tests will not be billed to your insurance and will be part of our bill to you.
Prescriptions will be covered under your current insurance as before.
I have commercial insurance; can you refer me to specialists?
For patients who have PPO insurance, there is not usually a referral required. For people who have HMOs with very strict network requirements, we may not be able to do referrals for you because of their rules. We strongly recommend that you check with your insurance company to find out if this will present a problem or not.
How can you charge a fraction of what you did before and still stay in business?
Because of the way the insurance companies and the government have interfered with the pricing of medical services, the prices have become overly inflated. It created a system where doctors were forced to charge far more than they ever expected to receive. Part of the bill goes to offset the administrative costs of cooperating with insurance companies.
By cutting out the middlemen, we cut out a lot of confusion, time, and overhead. If we know that we will actually be paid what we charge (like a plumber, bricklayer, or hairdresser), we can cut our rates dramatically.
Why don’t more doctors practice this way?
ALL of the doctors with whom we have talked before making our decision to change our practice are concerned about the future of medicine. Most are afraid of trying something new. The direct pay model has been working well in other parts of the country. We are proud to be the first practice in Maine to provide this service. Other doctors in Maine are following our lead.
Why have you stopped using an Electronic Health Record (EHR)?
We have found that using the computer for our medical records actually did more to get in the way of patient care than it did to make it easier. Also, we have concerns about maintaining patient privacy with electronic records.
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