annual professional fee $3,200  
co-pay none  
annual physical & comprehensive preventative health assessment yes  
additional visits included 12/yr  
HCGH in-patient visits included 7/yr  
fee per add’l visit over allotment up to $2001  
annual flu shot yes  
 
EKG, pulmonary function, routine office procedures (as needed) 2 yes  
direct access by cell phone & email yes  
blood draws & urine collections 12/yr  
telephone medicine consultation yes
  
prescription refills yes  
fax/email all test results yes  
pre-authorization forms3 yes  
prior authorization of medications3 yes  
review of tests & consults from other providers yes  
coordination & supervision of Emergency Room care yes  
travel medicine advice & admin of necessary vaccines4 yes  

1 depending on level of service & charged                  3 except when in-plan physician referral is required by

at Practice’s standard rates.                                              your insurance company.

2 routine skin procedures, ear lavage.                         4 cost of vaccines charged separately.