AUSTIN MEDICAL PARTNERS INTERNAL MEDICINE DIRECT PRIMARY CARE AND CONCIERGE MEDICINE IN AUSTIN TEXAS
IT'S TIME FOR A NEW NEW MEDICAL PARADIGM
FAQ%25253F.jpg

FAQ

 

Austin Medical Partners FAQ

 

 

Austin Medical Partners provides patients throughout Austin, TX with Direct Primary Care (DPC) and Concierge Care/Medicine (CC) on a membership basis. We also welcome people seeking weight loss and management services, body composition analysis and sports performance testing via DEXA Scanning Technology. While many are familiar with these unique services and what they involve, we understand the nature of our clinic may not be what you’re used to. Please check out the helpful FAQ below, and if you can’t find an answer to your question here, please contact our office today!

+ Do I need to enroll in a Direct Primary Care or Concierge Medicine membership plan to be seen as a primary care patient in the clinic?

YES. All patients who want Louis E. Ramos, MD as their primary care doctor are required to enrollment in one of our membership plans.

*Please note, the weight management/loss program, sports performance testing and/or body composition analysis are independent programs that DO NOT require patients/clients to belong to our membership-based direct primary care or concierge medicine model.

+ Is Direct Primary Care (DPC) a substitute for health insurance?

NO.

DPC is NOT insurance or a replacement for insurance. We strongly recommend all our patients maintain insurance in some form, either a traditional plan or a high deductible plan paired with a health savings account (HSA). We see DPC as a way to limit your healthcare expenses by reserving your insurance for more expensive healthcare needs, like surgery, prolonged hospitalizations, rehabilitation and expensive medications.

+ Which insurance plans work best with DPC?

Some people and businesses pair a DPC practice with a low premium, high deductible health insurance or health savings plan (HSA). Health Sharing plans, although not insurance, pairs well with DPC.

+ What is the difference between Direct Primary Care and Concierge Care/Concierge Medicine?

Both provide a personalized approach and better access to your doctor. Both emphasize the primacy of the “doctor-patient relationship” in medicine and not the interests of insurance companies or 3rd parties. The main difference is in how you pay. In the concierge model, we will bill your insurance. This is available for those with Medicare and private insurance in which our doctors are “in network.” However, you will still be responsible for your co-pay, co-insurance and deductibles. Medicare and private insurers with whom we are contracted/in-network restrict their subscribers from enrolling in a membership model like DPC. However, their members are allowed to be part of a concierge care plan. The concierge membership fee is not re-imbursible by Medicare or your insurance. It is specifically used to cover services that are not paid for by Medicare or Insurance, also know as non covered services.

+ Does Concierge Care provide services that are not covered by Medicare or private insurance?

The short answer is yes. Your concierge membership fees are used exclusively for non-covered services such as direct enhanced access, same day or next-day appointments, tele-medicine or virtual communication not restricted by the originating location of evaluation. In addition; certain imaging, diagnostic tests, labs, counseling and evaluations especially those that may be integrative, complimentary, alternative or functional medicine in nature are not covered by Medicare and most insurances. Certain screening test are restricted by medicare to specific time intervals and not covered at all if they occur more frequently. Some examples include bone density measurements, or screening EKGs.

+ One fee for highly personalized care, it seems so simple and too good to be true?

That’s the point of the DPC and the Concierge Medicine model. Administrative burdens are kept low allowing for more time with our patients.

+ How do you differ from traditional practice?

Our difference is in the amount of time with your doctor and the care coordination. One doctor taking care of most of your medical needs. This is only possible by creating a size-limited practice.

+ If I need hospitalization will I be followed by my doctor in the hospital?

Yes. At Austin Medical Partners we are unique as the only DPC and Concierge Practice in Austin that will admit or follow you during hospitalizations at Seton Medical Center Austin. If you are hospitalized at a non-covered facility*, we will provide personalized care coordination with the ER, Hospitalist and Specialist, leveraging our decades long expertise in Hospital Medicine.

*additional hopsitals may be added in the future

+ Does my DPC or Concierge Medicine membership cover hospitalizations?

No. Hospitalization are not included in your DPC or Concierge membership.

In the Concierge model, we will bill your insurance directly.

In the DPC model, we are considered an out-of-network provider and we will bill you or your insurance directly but only for the professional services that we provided you with while you were hospitalized. Our professional services fees are very competitve compared with the rates you would otherwise be billed for by a hospitalist working for a large national hospital medicine corportation.

+ Will DPC or Concierge Medicine save me money?

Each patient’s circumstance is unique and DPC or Concierge Medicine may help save you money. Here are a few scenarios where this is the case;

a) Decreased monthly healthcare cost. When paired with a low premium, high deductible insurance plan, the money you save on the premium may be much less than the cost of the DPC or CC membership.

b) Access to major discounts on common lab tests and medications.

c) Utilization of generic medications when efficacy is equivalent to brand-name medications.

d) Access to discounted imaging tests.

e) Enhanced availability with simple and direct access to primary care, ultimately avoiding costly trips to the ER or Urgent Care, and possibly the need for hospitalizations.

f) Less time away from work with appointments that start on time and phone or virtual appointments (when safe and appropriate).

g) During hospitalizations, enhanced care coordination to minimize your days in the hospital and ultimately the total cost of your care and your expenses.

h) No surprise bills.

+ Can I discontinue my membership?

Yes. After the initial 6 month commitment period, you may cancel at any time and for any reason. We do require the discontinuation request be written and personally signed. We will pro-rate your membership fee upon receipt of written notification to terminate.

+ If I discontinue my membership can I rejoin at a later date?

Yes. However and most importantly, all re-enrollments require a re-enrollment fee and may require a waiting period of 12 months from the date of discontinuation.

+ Can my membership or re-enrollment be declined?

Yes. Both DPC and Concierge Care are built upon providing highly personalized care through very low physician-to-patient ratios. Capping our patient panel to a fraction, in many cases 1/10th of a traditional practice, allows us to develop a deep understanding of our patients and provide more personalized care. Once the practice is at maximum capacity a waiting list will be created for those patients wanting to join the practice. When space becomes available we can add you to the practice based on your place on the waitlist.

Furthermore, developing a trusting doctor-patient relationship takes time and familiarity. Repeated disenrollment and re-enrollment is counter to our philosophy, in which case, our practice would not be a good fit.

+ Are there other reasons why my membership may be declined?

If we cannot provide the appropriate level and type of health care services your medical condition requires*, we will not be the right fit.

*Conditions we refer section at the bottom of the "Patients Tab"

+ Can the practice discontinue my membership?

Yes, in certain cases, such as a) if the patient fails to pay the direct membership fee; b) the patient has performed an act that constitutes fraud, for example, prescription forgery, misuse or diversion of controlled medications or non-controlled medications; c) failure to comply with a recommended treatment plan, including repeated missed appointments; d) the patient is abusive or disruptive and presents an emotional or physical danger to staff or other patients of the practice; e) if the direct practice discontinues operation as a direct care practice or discontinues practice altogether.

+ Can I use my HSA or FSA account to pay my monthly membership fee?

It depends on your HSA or FSA plan. Please refer to your HSA or FSA plan for specific details. We can accept HSA and FSA funds; however, it is your responsibility to ensure use is in accordance with the IRS and applicable tax laws.

+ Will Medicare or private insurance cover my concierge medicine membership fee?

No, Medicare and private insurance do not cover concierge membership fees. Your membership fee goes toward services that are consider non-covered services. Some example of non-covered services include personal training, certain complimentary or alternative medcine evaluations or non-covered imaging or services such as body composition scanning, or sport performance testing such as VO2 Max testing.

+ Why is the DPC payment model not available to Medicare patients or patients who want to use their insurance?

Medicare regulation requires a claim or bill to be submitted for each specific visit and specifies a specific fee for each service rendered. The DPC payment model is different in that each visit is not dependent on satisfying this regulatory requirement. Medicare only allows patients to participate in a membership-based practice through a Concierge Care payment model in our practice as we are not opted out-of-medicare. This also applies to patients with private insurance with whom we are in-network. Our Concierge Care model does allow access to additional services beyond what Medicare or insurers allow in a traditional fee-for-service model.

+ Can I participate in the clinic’s weight management or Fitness & Sport Performance programs if I am not an enrolled as a member of the DPC or Concierge program?

Yes. These are separate comprehensive programs that evaluate your nutrition, sport performance and cardiovascular fitness. We can make recommendations for your PCP to follow if they are interested. We can follow and track your fitness and it's improvement over time and the implications for your health. These evaluations are more focused when not paired with DPC or Concierge Medicine Programs. Enrollment in our DPC and Concierge Care programs allows for the most integrated approach to manage your weight, nutrition, fitness and sports performance in the context of your personal medical history and your overall health and wellness. We are the only practice in Austin providing this service.

+ Can I use my insurance to pay for labs, imaging and medications?

Yes, we actually recommend this. We, however, are not responsible for costs not covered by your insurance plan. Austin Medical Partners has negotiated and access to cash-pay prices with local labs and imaging facilities. In addition, we have access to discounted medications that are a fraction of what these same providers will charge your insurance plan. Many times it costs less for you to pay the cash price, using your HSA or FSA debit card, than the co-pay for you insurance. This is particularly true for medications.

+ Can I submit my DPC office bills that aren’t covered by my DPC membership fee for re-imbursement to my insurance company?

Yes. We will give you a document with all the appropriate codes so you can file this with your insurance company. Outside of providing appropriate documentation codes we do not assist otherwise in the insurance billing process.

+ What if I’m still unsure if membership medicine is right for me?

Call us for a free 10-20 minute informational phone meeting to answer your questions. And if you still have questions, we’ll schedule a time for you to visit the clinic in person to see if it’s right for you.