I’m not sure I understand how a retainer practice works. Can you describe the model?
Dr. Carlson’s restructured practice is a small, independent, solo internal medicine practice, which is characterized by a direct, financial relationship between the physician and the patient and takes health insurance out of the equation. This will help restore the doctor-patient relationship of the past, unencumbered by insurance company policies and provider-network constraints. Dr. Carlson does not participate with any insurance plans, including Medicare. An annual professional fee is assessed to each patient.
Is this a type of medical insurance plan?
No. This is simply a medical practice model that will allow you to see Dr. Carlson without the restrictions and complications often associated with insurance companies.
I have good health insurance; doesn’t that pay for this already?
For services to be covered under most plans you need an office visit. This may require waiting for an appointment, taking time off work to sit in a medical office or urgent care waiting room, possibly requiring childcare or paying unnecessary transportation costs. For Medicare patients, with the exception of the first physical in the enrollment year, Medicare pays for no physicals or preventive care. Simply put, serious problems need to be diagnosed and treated in a timely fashion, not when there is an opening in a busy schedule or to be treated by someone who has limited knowledge of your medical history. Insurance does not pay for any enhanced services or conveniences that this plan offers.
Do I still need my medical insurance if I join?
Yes. This is not meant to replace your health insurance and you should keep your private insurance. You will need it to help cover the cost of specialist visits, hospitalizations, labs, x-rays and other fees that typically arise outside of Dr. Carlson’s office and to help cover the cost of medical services provided by Dr. Carlson’s practice outside of the annual professional fee (where permitted).
Does it matter what kind of medical insurance I have?
No. Dr. Carlson does not participate with any insurance.
I’m covered by Medicare. Can I see Dr. Carlson?
Yes. Dr. Carlson has opted out of Medicare, which means that she does not participate in Medicare’s programs. This does NOT mean that she cannot care for Medicare patients, nor does it mean that Medicare patients must forfeit their coverage by Medicare. It means that neither she, nor Medicare patients, may bill Medicare for any portion of the professional fee or any other related expenses. Medicare patients sign a private contract acknowledging that they agree to a private relationship with Dr. Carlson. The patient’s Medicare coverage still applies to other doctors, hospitals and Medicare-covered services.
I am covered by an HMO. Can I see Dr. Carlson?
Yes. However, if you belong to an HMO, a doctor in that HMO’s network must act as your Primary Care Provider (PCP) for required approvals and referrals. You may still join as long as you understand that for the purposes of your HMO, Dr. Carlson cannot act as your PCP, nor will they cover the cost of the professional fee.
I am in a Preferred Provider Organization (PPO). Can I see Dr. Carlson?
Yes. While you will be responsible for the annual professional fee, you may be able to submit bills to your insurance company for reimbursement. Since Dr. Carlson is not affiliated with any insurance companies, any reimbursement is appropriately yours to keep. For insurance purposes, Dr. Carlson is considered an “out of network” physician. Reimbursement levels are determined by your particular policy and may be subject to an annual deductible.
Can I submit to my insurance provider for possible reimbursement? And how would I do that?
Probably yes, but check with your insurance company. At each appointment, you will be given an itemized invoice for all services rendered representing the reasonable value of the services provided. If your insurance company permits it, you can then submit a claim to your insurance company for possible reimbursement after you have met any out-of-network deductible. Any reimbursement received from your insurance company belongs to you since your annual fee covers your expenses. You should check with your insurer before submitting an invoice for reimbursement.
I have a Flex Spending Account (FSA) or Medical Expense FSA through my employer. Can I access that for any reimbursement?
Probably yes, but check with your plan administrator. Many patients submit first to their insurance provider. Anything not reimbursed, including your deductible, may be eligible for reimbursement from your plan. By using pre-tax dollars designated for medical expenditures, you may find these plans could reduce your out-of-pocket costs by as much as 30 to 40%.
Can I use my HSA to cover the retainer fee?
Possibly yes, however, if you decide to use your HSA money to pay for the professional fee, consult your accountant first.
Will Dr. Carlson see me if I am hospitalized?
If you are admitted to Howard County General Hospital, Dr. Carlson will continue to see you as her patient. Please note that Dr. Carlson is one of only two local Internists that continue to see their patients in the hospital. Dr. Carlson strongly believes that this is when a patient most needs to be followed by their own physician to assure continuity of care.
Will Dr. Carlson assist if I am in the Emergency Department?
If you, for whatever reason, are in the Emergency Department at Howard County General Hospital, Dr. Carlson will supervise your care and meet you there if she deems it necessary. Again, she is one of only two local Internists who continue to provide this service.
Will Dr. Carlson make house calls?
Yes. Dr. Carlson will continue to make house calls when she believes it is not practical or possible for the patient to be seen in the office and when hospital evaluation and tests are not necessary. When Dr. Carlson believes a house call is appropriate, it is included in the annual professional fee as a visit.
How can I reach Dr. Carlson?
Dr. Carlson is available to her patients 24 hours a day, 7 days a week, with the exception of vacations and unexpected emergencies. There is no answering service. For routine or non-urgent matters, you have the option of calling the office or sending an email or fax. If you need to speak with Dr. Carlson regarding an urgent matter, you may contact her at the office during office hours or directly by cell phone after hours. If she is not able to take your call immediately, she will contact you as quickly as possible, usually within 10-15 minutes.
What happens when Dr. Carlson is away on vacation or unavailable?
Dr. Carlson will make arrangements with an experienced Board-Certified Internist to provide outpatient coverage during infrequent times of unavailability. These professionals are as accommodating as possible. Every attempt will be made so that patients admitted to Howard County General Hospital are cared for by the qualified covering physician.
Can members of my family who are not current patients of Dr. Carlson join?
Yes, assuming there is space available. They can either stop by the office to fill out the forms or request further information by email.
What happens if I move away or have to leave the practice? Will I be reimbursed some portion of the annual professional fee?
Yes. If you need to leave the practice for any reason, you will be reimbursed on a pro-rated basis based on whole months remaining in the contract year. If you have already received your Annual Physical Examination for the year, then $600 will be deducted from any pro-rated refund owed to you.
Why is this type of practice right for me?
This type of practice evolved in response to the failure of our current health care system. Medical practices that rely on high patient volume do not always have time for all of the needs of each patient in their practice each day. Long waits and short appointments have become the norm. Urgent patient needs often interrupt thorough routine and preventive care. That is one reason few primary care doctors take care of their own patients in the hospital. Overnight and weekend call is spread out by so many providers that the chance of your doctor being available to you in an emergency, when you need your doctor most, is very small. This practice offers you a partner in your health, when you are well and when you are sick. I choose to be a doctor with time to listen, communicate and advocate for you.
How can I obtain further information?
If you have any further questions, please send an email to: Eric@KevinCarlsonMD.com
Or you may call 410-910-7444 and leave a message with best times to call you back to discuss any questions.