I have a high deductible major medical
insurance plan or right now I am not covered by insurance, is becoming a
"LAM" a good expense for me?
Answer:WE THINK SO!!! Having a relationship with PCC
should help you make better choices in spending your health care dollars. Just
look at the out of pocket expense of going to a traditional "insurance
driven" primary care practice, or for that matter an urgent care center or
emergency room. More importantly, more time is allowed for your attention with
Why have you decided to not take
insurance or Medicare?
Answer: There are many excellent primary care
physicians available in "the system." It is our opinion that it
really comes down to the old "time and money" line. In the
"insurance driven primary care provider services" model, to maintain
an anticipated income with declining fees primary care physicians are trying to
see more and more patients per day. All office visits result in more
"work" then the encounter itself (record keeping, etc.) and more
costs that tend to be under appreciated. This scenario has a constant negative
"pressure" to health care satisfaction for everyone, patient and
doctor alike and ultimately healthcare quality.
Primary Care Consultants our answer to this issue is simple. We will avoid this
"negative pressure" by not playing the insurance game. We will have
membership fee included with your annual exam and a simple fee for service
schedule that covers our anticipated needs, allowing plenty of time to be with
the patient, not the paperwork. We will strive to avoid the
"overbooked" scenario so common in primary care medicine.
We also feel strongly that the "traditional insurance model" puts the
physician in situations that are not always in the best interest of the
we advocate that insurance should not be playing the role it does, in today's
market, in paying for basic primary care provider services. It is our opinion,
that in many instances of primary care provider services, insurance actually
reduces the incentive for provider and patient to consider costs and increases
the overall cost of health care. Insurance should, in our opinion, be for major
Will becoming a "LAM" of
Primary Care Consultants P.C. take care of all of my health care needs and
Answer: No! and No! Most costs for health care
are not provider charge related. PCC will attempt to offer excellent quality
primary care services. It cannot however meet all health care needs. Example:
If a "LAM" has a severe laceration the clinician may feel it is in
the best interest of the patient to not repair the wound at PCC and refer the
patient elsewhere. Another example would be a patient with chest pain
indicative of a heart attack would need to be cared for at the hospital. Again,
such referrals would not be covered by the PCC fees.
Is this a "boutique medicine"
Answer: NO! Not in our opinion. Primary Care
Consultants is an attempt to return to a simple cash model primary care doctor
that allows the doctor more time to develop a therapeutic relationship with
If you investigate "boutique medicine" practices in the area you will
see access fees many times higher.Our
goal is quality Family Practice medicine in a non-harried environment.
Why "by appointment only"? What if I need to see you right away?
Answer: We request that all patients call, or e-mail any appointment request
(and receive confirmation from us regarding any such request) before arriving
at the office. This will ensure that you get full attention for your needs.
Please understand that time for same day appointments for sick visits are
allowed for in the schedule. So if you wake up sick or are injured please call!
We will get you in! But call first!
Why is the "limited access fee" necessary?
Answer: It is part of your annual exam cost and establishes who actually wants
to be a member of the practice and provides a necessary cash flow to cover base
What happens if I get sick and the doctor is out of town?
Answer: The doctor will arrange for Limited Access Members to have telephone
coverage either by himself or another clinician when he is out of town. If, in
the judgment of the clinician on call, the patient requires attention that
cannot wait until the office reopens then the patient will be referred to an
urgent care facility or to an emergency room. (Note: physician care and any
other costs at these facilities are NOT covered by fees you have paid to
Primary Care Consultants, P.C.).
Why is it called Limited Access Membership (LAM)?
Answer: Because that is what it is! No physician can be all things to all
people, nor can he/she provide quality care if working "24/7" 365
days a year. The term Limited Access Membership is used purposefully to highlight
to members that this is principally a commitment to provide cognitive primary
care services for outpatient care.
Will my insurance cover the fees of Primary Care Consultants, P.C.?
Answer: It depends. Some plans will directly reimburse a member all or a
portion of the charges for seeing a "non participating provider" for
care. You have to read your policy. Medicare will not reimburse any charges.
Can I use money from a "health flex spending account" set up through
my employer to pay for Primary Care Consultants, P.C. fees?
Answer: Generally, yes. Please consult the plan and seek any tax advice you
deem necessary from your accountant or other qualified adviser.
I have a major medical plan. Will lab tests, X-ray and diagnostic tests be
covered if Primary Care Consultants, P.C. writes the orders?
Answer: Generally, yes, but the insurance policy determines coverage. Every
effort will be made to send you to a facility that accepts your insurance.
Medicare patients will also have Medicare coverage for any tests if done at a
Medicare participating facility (i.e. Saint Mary's Hospital).
What if I have to go to a "participating provider" to have a test
Answer: Though rare, in such an instance you would be given a letter
documenting why Primary Care Consultants, P.C. felt the test was necessary, for
you to take to an "in network provider" to order the test (note: the
cost associated with seeing a "in network provider" for such a visit
would be yours and is not covered by the fees charged by Primary Care
Why do I have to sign a "Limited Membership Agreement"
Answer: We live in a lawyer's world! There have to be clear boundaries.
The agreement serves to protect the Primary Care Consultants, P.C. and its
physician from unrealistic member expectations.
Yet remember, ultimately, the member is in control because he or she can always
"fire" the doctor. Our goal is for that to never to be the case.
What do I have to do to show financial hardship?
Answer: Present the physician with a letter of explanation regarding your
situation with proof of limited financial resources (income tax return,
Medicaid status, etc.)
What if I need to see the doctor for a sick visit or need a medicine refill
Answer: You first have to register, fill out a "ihealth record", sign
a LAM agreement, pay your LAM fee and schedule a CE. Then call for an
appointment or send an e-mail through the Medem practice website (if your
"ihealth record" is detailed enough the physician may choose to refill
medicines without seeing you).
I would like to meet with the physician and ask some questions about the LAM
contract before I sign up. Can I do that?
Answer: Yes, brief 10 minute appointments can be scheduled for this (call
804-282-3495). Please understand that this can not be used for medical
evaluation and treatment, nor serve as a means to establish a relationship with
the Physician or PCC.
How do I sign up?
Answer: as per above
- First register through the website Home Page: http://www.infopcc.com/
- In the Patient log in box click "New to our site?" and complete the
registration information. If you do not have internet access or need help call
and schedule a time with the office to help you with this.
- Second follow the prompts to complete your "ihealth record." Again,
if you do not have internet access or need help call and schedule a time with
the office to help you with this.
- Third: Call to schedule a time to come by the office and sign a LAM agreement
and pay your LAM fee.