*New patient centered healthcare business model.
This message is also intended to address questions surrounding Concierge/ Membership & self-pay or submitting own invoices to insurance.
We are opening Monday through Friday 8A-5P; & Walk-in 1-4:30 for established patients.
Question #1: What does being opt out Provider mean and what does that mean for patients?
Opting out of insurance will provide much greater flexibility in patient care, more time for care rather than behind the scenes paperwork, bureaucracy, and actually keeps healthcare costs much lower overall as we can see self-pay patients for half or even much less than that for membership, concierge patients.
Certainly some believe that opted out Providers do not want to see patients on Medicare or other government programs. This is far from the case. We are happy to see Medicare patients; in fact at least a third to half of our practice have been Medicare & Medicaid patients.
As I have been in Medicare for the majority of my career, I can speak for both sides of the story here. When accepting Medicare providers have to play by their reporting rules and go by their guidelines. Otherwise they’re not going to cover the visits and they’re unlikely to pay for the care needed for the patient. The only way to succeed with standard insurance in family practice is to run a factory and many have probably been to an healthcare setting where they feel like just a number and wait an hour to be seen for five minutes visit, and really don’t receive much communication. We do not want that model. Our goal for being in medicine is to develop relationship with people and make a difference in their lives through healing the sick, limiting disease, & focusing on outcomes. Our mission is to care for mind, body, soul. This freedom from beurocratic, cookie cutter care allows us to focus on the patient.
*Note: We do not believe mandates and generalized guidelines that are a one-size-fits-all are conducive to mission of excellent, holistic, and individualized care.
Question #2: Will insurance pay for any lab or radiology service that are ordered?
Medicare & other insurance plans will cover orders sent to the hospital per your individual plan coverage. They do pay for the x-rays they pay for the laboratory they pay for specialists, referral for surgery, similarly as orders from a clinic accepting insurance.
Question #3: Can patients submit an itemized invoice to Insurance for reimbursement?
For Medicare and Medicaid, the answer is no, as opted out agreement means the patient is responsible for the cost of services however most commercial, private insurance insurances, and even some government entities such as Tricare will reimburse at their usual rates. We are happy to provide itemized invoice to patients at the time of service.
The opted out physician and the patient becomes a fee for service approach and we try to make our fees quite affordable, expanded access… every patient has the Provider’s cell phone, and excellence in care across-the-board.
Question #4: How much does a self-pay visit or concierge, membership plan cost?
Our membership plan is $50 per month for adults, $25 for minors and maximum of $175 per month for large families. Once you’re established, our self-pay visits for non-membership patients are just under $100 per visit.
Membership includes unlimited, even daily visits if needed, home visits in some cases, and most clinic procedures along with discounted labs, and every patient has our cell phone numbers. With the time that is saved via bypassing insurance paperwork, we are able to even give after hours phone care.
I’m sure there are even more questions and we will be available to answer those in the days ahead but wanted to give our patients a good explanation and comfort as we reopen the clinic under this business model.
Blessings to all this Christmas Season and here’s to an healthy New Year!
Sincerely,
David S. Costner, FNP
Owner/Provider
Costner Care Family Clinic
406 West Railroad Ave.
Plains, MT 59859
Office: (406)540-5757
Fax: (406)540-6363
