FAQ

Why is there a practice membership fee?

Without this, I’d need to charge much more for office visits or have many more patients,
and therefore not be able to provide the same level of responsive and personal service.

This fee includes services that are not typically covered by health plans and for which
some medical practices charge itemized fees. This includes telephone and email
consultations, medication refills, and completion of medical forms.

Having a practice membership fee allows me to keep track of how many patients I have at any time so that I can keep my practice to no more than 300 patients

Why are some concierge medical practices charging higher annual fees?

Some of these practices include all visits with the physician, so they have to include the
potential costs of multiple visits per year for each patient even if they might not be needed

Some include an “executive physical” and possibly also multiple tests in the annual fee (see related questions below)

Some of these concierge physicians will accompany their patients to specialist visits or go to a patient’s workplace to provide care, and this requires having a much more limited
number of patients so that a higher annual fee is required to make it financially viable

I will not do either of these things but can be very involved in discussing a patient’s carewith any specialist that may be involved.

Why is your medical practice “cash only?”

This allows me to get out from all insurance contracts, which have steadily forced lower
and lower reimbursements on physicians resulting in a need to increase patient volume in
order to maintain a certain income.

This allows me to get reimbursed the same by each patient so there is no need to charge a higher per-service fee that allows for cash-paying patients to subsidize those patients whose insurance plans pay much less than what is charged.

In summary, it means that I work for my patients instead of the insurance companies

Does “cash only” mean you don’t accept checks or credit cards?

Certainly not! Checks and credit cards are welcome.

Many Health Savings Accounts (HSAs) provide a debit card for payment of medical
expenses directly from a patient’s account.

Is my practice membership fee refundable?

Yes. A patient can resign from my medical practice at any time and the fee for any
unused months will be refunded.

Is my practice membership fee reimbursable by my health insurance?

No.

Are my office visit fees reimbursable by health insurance or HSA?

These fees are reimbursable by HSAs.

These fees are reimbursable at the non-preferred provider rate by fee-for-service
insurance.

These fees are not reimbursable by capitated managed care health plans (HMOs).

These fees are not reimbursable by Medicare.

Why are none of the office fees reimbursed by Medicare?

I have chosen to opt out of Medicare. Opting in to Medicare would require that I accept the low Medicare rates and require that I bill Medicare for my services, which in turn would raise my overhead and result in higher fees for my other patients.

Unfortunately, opting out of Medicare means that my patients are not allowed to submit a bill to Medicare for reimbursement of expenses paid to me (this is a federal government regulation)

Can I see you if I am covered by Medi-Cal?

No. I am not contracted with Medi-Cal and physicians cannot collect cash payments from Medi-Cal patients, even for services not covered by Medi-Cal.

Why doesn’t the practice membership fee cover an “annual physical exam” like some concierge medicine practices?

Not everyone needs a physical exam or large panel of tests each year, so why have my
patient pay for something that might not be needed? I follow published guidelines to
recommend what examination and tests, if any, are indicated each year, and together my patients and I determine what tests are ordered

Carving out the physical exam allows for a patient’s payment for this to be reimbursed by the patient’s health insurance company (HMOs and Medicare are the exception) as
practice membership fees (a.k.a. retainer fees) are typically not reimbursed by health
insurance companies. Preventative care visits are not subject to a deductible.

Some concierge practices also include multiple tests such as screening blood tests,
electrocardiograms, stress tests, chest x-rays, and breathing tests as part of the
annual fee...why won’t you do that?

Some of these tests are not on the list of recommended screening tests put out by
various organizations, and others that are indicated certainly don’t need to be done
annually. As noted above, I choose to instead follow published guidelines for preventive
medicine care and therefore only recommend screening tests that are medically-indicated according to these guidelines.

Why doesn’t the practice membership fee cover office visits?

For the same basic reasons as noted above for annual physical exam:

• Why have a patient pay for more care than might be needed
• Office visit fees are reimbursable by the right type of health insurance, whereas the practice membership fee is not, so these need to be separate items

If I call or email for an appointment, do I have to describe all my symptoms in
order to schedule an appointment? In other words, do I have to prove that I am
sick in order to get a same-day or next-day appointment?

Absolutely not! Just let me know that you want to come in and I’ll get you scheduled (and I’ll see you on time!).

This policy includes routine follow-up appointments in addition to acute illness
appointments.

Do I still need health insurance if I’m paying you directly for your services?

I am happy to see patients who have no insurance, but if at all possible you should have insurance, even if it’s just high-deductible insurance for a potential medical catastrophe.

Your insurance may reimburse you at least a portion of what you pay me (see below)

Insurance is needed to help with the cost of tests, specialist care, hospital care, etc.

If you have medical insurance and join my practice, you may decide to switch from an
HMO plan or a low-deductible PPO plan to a high-deductible PPO plan and use the savings in insurance premium to help pay for the practice membership fee. A high-deductible insurance plan is truly for catastrophic healthcare, as insurance was originally meant to be. Compare this to automobile insurance, which you similarly hope to never need for the car for which you pay separately as needed for routine servicing (equivalent to a preventive care visit) and for mechanical problems (equivalent to an office visit for an acute illness). By not paying an HMO to manage your healthcare dollars, you instead get to decide how you want to spend (or NOT spend) your healthcare dollars.

Do you make house calls?

Yes, when medically indicated

Are you affiliated with any hospitals?

I have affiliate medical staff privileges at the UC San Diego hospitals in Hillcrest and La Jolla

I have affiliate medical staff privileges at Scripps Memorial Hospital in Encinitas

This allows me to have online access to my patients' medical records at these hospitals.

Will you take care of me in the hospital?

My patients much better served by having the excellent "hospitalists" at the
above-noted hospitals manage their in-patient care. I guess that makes me an "officist."

I will can have contact with these hospitalists so that I can have input as a member of a patient’s healthcare team, and I can visit patients in the hospital as needed.

Are you really available 24/7 to your patients?

Yes, I am on-call for myself daily and will arrange coverage by a colleague only in very
limited circumstances such as illness or travel out of cell phone contact.

Aren’t you afraid that you’ll burn out by being on-call every day?

No! There are several reasons for this…

• The practice has a limited number of patients
• Patients will know that they can easily reach me the next morning, so that may eliminate the need to call at night
• Since opening my practice I’ve been awakened by a patient phone call only a few times

My medical practice is based on mutual trust and respect.