Frequently Asked Questions
Do I still need health insurance?
Yes. Concierge Medicine memberships do not take the place of health insurance coverage. You should continue your PPO, Medicare or other insurance coverage.
Are you a provider for Medicare?
Yes. We are a participating provider for Medicare and will bill Medicare on your behalf, as required by law.
What are the fees?
The annual fee ranges from $1000 to $2,000 depending on the membership level you wish to join.
What exactly is covered by the membership fee? What services are billed to insurance?
The annual membership fee specifically covers those added services listed under each plan, but the fee also indirectly powers the patient advocacy and VIP services. Click here to see which benefits apply to each level. All treatments and visits are billed to insurance, just like standard medical practices do. The patient remains responsible for any co-payments, deductibles, etc. required by their insurance carrier for such visits.
Do you have payment plans?
Yes, for our Platinum Membership level only. For all other levels, patients pay the annual fee in one lump sum at the beginning of their membership year. This is especially true insofar as the doctor typically performs many of the major concierge services (comprehensive exam, review of past records, formulation of a health and wellness plan, etc.) early in the year. For our highest level tier, Platinum Membership, you will have the opportunity to pay in one, two or three installments over 3 months. This payment plan is not available when enrolling online, please call for more information.
Is my concierge fee tax deductible?
Your fee may be reimbursable from a HealthCare Reimbursement Account or Health Savings Account and as such may be tax deductible, but you are advised to consult with your tax preparer or accountant.
Can I use my Health Savings Account?
You should be able to apply funds in your HSA to most if not all services and supplies provided to you. However, again, you are advised to consult with your tax preparer or accountant.
Can I submit my annual fee to my insurance company for reimbursement?
Most standard health insurance carriers do not pay for the membership fees.
Do I still use my insurance coverage for routine and episodic visits?
The office will continue to bill you or your insurance company for routine visits normally billed by doctors' offices. The membership fee does not cover these services.
What about lab, X-ray, specialists' fees and hospitalization?
These costs are neither covered by your membership fee, nor billed by the clinician’s office. All these and other services will be billed by the healthcare entity performing the services and should be covered as "in-network" benefits. You should check with your insurance company directly regarding these services.
What about prescription medicines?
Prescription medications are the patients' responsibility and are usually covered by a separate prescription drug plan. Your clinician works with you to get the most optimal coverage of prescriptions possible under your plan coverage.
What do I do if I have an Emergency?
For a life-threatening emergency, immediately call 911 or go to your nearest Emergency Room. Once you have gotten immediate medical help, contact your Concierge Medicine Clinician (or have a family member call) as soon as possible so they can quickly step in to provide and coordinate appropriate medical care and referrals.
For non-life-threatening emergencies (such as Urgent Care), contact your Clinician’s Office first by phone, email, or text to inform your Clinician about the urgent or emergent problem you are having.
Who provides medical coverage when my Clinician is not available?
In the event that your Clinician is unavailable due to illness or vacation, your care will be reasonably and professionally handled by their office staff via: direct contact by email, or text, or by the use of colleagues within the Main Street Physicians Care Network.
Can I get a refund if I terminate my relationship early?
No. Your enrollment is annual and nonrefundable.
Why did Main Street Physicians Care decide to change their practice to a Concierge Practice?
As our practices have grown, our level of frustration has increased due to the inability to give you as much time and attention as you deserve. We believe our job is to help guide you through the complicated healthcare system, to assist you in understanding the ever-expanding options in the modern medical field, and to be your strongest advocate. You deserve our fullest attention to every detail of your healthcare. A concierge practice is a way of limiting the number of total patients in a medical practice, so that the doctor can spend more time with each individual patient.
Why is an Annual Enrollment Fee required?
The Annual Enrollment Fee is a membership fee to ensure limited patient enrollment, which optimizes the doctor to patient ratio.
Does our health insurance cover the Annual Enrollment Fee?
Commercial insurance plans do not cover the Annual Enrollment Fee.
Can the Annual Enrollment Fee be applied to our deductible?
The Annual Enrollment Fee cannot be applied to your insurance deductible. However, if your employer has a Flex Plan (Section 125) or a Medical IRA, you may be able to receive reimbursement for the Annual Enrollment Fee with these pre-tax dollars. We recommend that you talk to your employer or tax advisor for more information about this.
Can the Annual Enrollment Fee be applied to my office visit co-pays?
The Annual Enrollment Fee cannot be applied to regular office visit co-pays. However, there will be no co-pay or out of pocket expenses for your Annual Comprehensive Wellness Examination through Medicare. You are advised to confirm with any other Insurance Carrier if your annual wellness exam works the same way. Your co-pay will only apply to any additional office visits.
I am a Medicare patient. How does our insurance plan apply to their program?
Although Medicare rules and guidelines are quite complicated, Medicare patients may join our practice. For more information related to Medicare coverage, please see below.
How does Main Street Physicians Care Work With my Health Insurance?
Main Street Physicians Care is a membership program that is designed to work in conjunction with, not replace, your traditional health insurance. The Concierge Medicine program is designed to work with most commercial insurance plans and with Medicare.
1. Commercial Insurance (Non-Medicare, Non-HMO) Plans:
If you are insured by a commercial insurance plan, you must maintain your health insurance. When you require care (other than your Annual Comprehensive Wellness Examination), your insurance will be billed at Main Street Physicians Care’s usual and customary rates for your office visit. Our fee schedule will remain the same.
You will need to continue to use your commercial health insurance for any visits with medical specialists and for hospital, imaging, and lab services.
If Medicare is your primary health insurer, you must maintain your Medicare coverage. When you require care, Medicare (and your secondary insurance if applicable), will be billed at the usual and customary rates for your office visit. Our fee schedule will remain the same.
You will need to continue to use your Medicare and commercial health insurance for any visits with medical specialists and for hospital, imaging, and lab services.
Why do I have to pay an enrollment fee just to be able to see my doctor, in addition to paying my insurance deductible or co-pay?
The annual membership fee specifically covers the added services listed under each level of enrollment, but the fee also indirectly powers the patient advocacy and VIP services. Those patients wanting fewer added services and/or a lower enrollment fee may enroll in a lower-level plan of their preference.
Problem-based visits, urgent care, hospital verbal consults, house calls, injectable medications, and visits for chronic or episodic problems/concerns are billed to insurance, just like standard medical practices do. The patient/member remains responsible for any co-payments, deductibles, etc. required by their insurance carrier for such visits.
Does each person in a household have to pay the enrollment fee? Is there a maximum number of fees charged per household?
Yes, each individual wishing to be treated by their Concierge Provider will need to enroll in a concierge plan, regardless of relationship or number of family members in their household. There is no cap to the number of individual fees that will be assessed within a household.
However, if you and your spouse are both over the age of 70 and patients of Main Street Physicians Care, your spouse's enrollment fee will be reduced by one half. Only standard enrollment is available online, so please call 855-411-0272 to take advantage of this dual enrollment option.
I need more time to make a decision. Can I join Concierge Medicine at a later time?
Main Street Physician’s Care will only see non-Concierge patients until January 31, 2015. After that time, non-Concierge patients may enroll as an Main Street Physician’s Care Concierge patient only until that Concierge practice is full. To be fair, we cannot hold spaces in our practice. After January 31, 2015, our Clinicians will dedicate 100% of their time to our Concierge patients. Any patients choosing not to join Concierge Medicine will be assisted in transferring to another physician and all patient records will be provided.
Concierge enrollment is permitted year-round, however space is available for each plan and each clinician on a limited basis.
How many patients will be enrolled in Main Street Physicians Care Concierge Medical Care practice?
Our Concierge practice will be limited to a few hundred patients per doctor. Limiting the total number of patients will ensure that each patient receives the highest level of access, individual care and service from our Clinicians.
What are the benefits of membership in this practice?
- Limited patient enrollment
- Enhanced communication access to your doctor via mobile phone, texting, and email
- Office visits that start on time and last as long as needed
- Same-day appointment availability based on tier
- Annual Comprehensive Wellness Examination
- Our continued commitment to personalized care with an emphasis on wellness and prevention
- Dedicated support staff
- Coordination of specialty referrals
- Fitness consultations
- Nutrition consultations
- Medical Advocate during inpatient care
- Pre-operative evaluations
- Benefit availability will vary depending on level of membership. Click here to see which benefits apply to each level.
What is included in the Annual Comprehensive Wellness Examination?
- Collection & review of medical history
- Review of recommendations from consulting physicians
- Comprehensive physical examination
- Stool examination for blood
- Spirometry (if indicated)
- Vision Exam (if indicated)
- Review of laboratory testing
- Establishment of a written screening schedule based on national guidelines
The Annual Wellness Examination will be performed by our Clinicians without any additional out-of-pocket expenses by Members for in-house services. Services that are not covered by the Annual Enrollment Fee include: testing at outside facilities such as blood tests, x-rays, ultrasound exams, MRI/CT scans, colonoscopy, heart stress tests, etc.
What do I do when I need a specialist?
To ensure continuity of care, we will help coordinate all specialist referrals. We feel communication between primary care physicians and sub-specialists is crucial to your health. (Available at Platinum Membership Level only.)
If I only come to the doctor a few times a year, what are the benefits of joining Concierge Medicine?
We believe health and prevention of disease should be a top priority. As one ages, there tends to be a greater need for healthcare. We believe this is a wise investment in your health. As you will find, many physicians are moving to a concierge style of practice in order to better serve a smaller number of patients.
How do I enroll in Concierge Medicine?
You can enroll by phone at 1-888-847-3912 or online at . Payment will be required at the time of enrollment. Click here to begin!