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Affordable

office visits (no insurance required or needed):

$10 or $20 for Access Medical Home Members – depending on which option you choose.

$59 for non-members

This is a 40-50% decrease in expenses. With your insurance there is the usual level 4 visit of $105 – $110 charge.

Your lab work is still billed by the lab companies to your insurance (private insurances and Medicare). So, there is no change in this regard – it is just like it has always been. Well, with one exception… for many people purchasing certain lab work directly through the clinic will be cheaper than paying for it through your insurance.

 

2 Ways to Become a Medical Home Member:

#1 – Have an Annual Comprehensive Evaluation

#2 – Or, simply sign up for one of the two options to become an Access Medical Home Member.

afforbableNOTICE: Potential good news!? Obamacare is forcing your insurance to cover 100% of preventive care as they define it (does not include Medicare or Medicaid – they will not reimburse you). Therefore, if you have private insurance and you have an Annual Wellness Evaluation at Access Medical Home, your insurance might reimburse you the full cost of all that qualifies as preventive care depending on your out of network benefits. You will want to verify with your insurance exactly what they cover so you will have a better idea if they will reimburse all or a proportion of your cost for the exam. Access Medical Home cannot guarantee or predict what your insurance will reimburse you.

The good news is that when you pay for your Annual Wellness Evaluation you automatically become an Access Medical Home Member for the following 12 months and receive all of the discounts, added services and benefits that come with being a Access Medical Home Member.

 

When you have an Annual Wellness Evaluation { Member Plus option ($770), or Member option ($530) } your regular office visits for the following 12 months will be either:

  • $10 overhead and scheduling fee when you choose the Member Plus option, or
  • $20 overhead and scheduling fee with the Member option.

Additionally, most basic testing is no additional cost. These basic tests (available if needed at no extra charge) are all inclusive with the $10 or $20 fee are as follows:

  • CBC (complete blood count)
  • BMP or CMP – [basic or complete metabolic panel (BMP = glucose, electrolytes (sodium, potassium, calcium) kidney function; CMP = a BMP plus liver function tests]
  • UA – urinalysis
  • Hemaglobin A1C
  • Random Blood Glucose
  • Pulse Oximetry (measures oxygen in blood)
  • EKG

What is included in the Annual Wellness Evaluation? – see full description depending on what three categories you fall in:
#1 Do you have insurance? Yes, or NO

#2 Are you male, female or child (ages 1 to 17)

#3 Are you a Member, or Non-member? Which are you choosing?

Your options may vary depending on these three answers. Click on the link to see what comes with an Annual Wellness Evaluation. Annual Wellness Evaluation Benefits

Generally speaking your Annual Wellness Evaluation comes with the following:

  • pap smear for women if indicated – annual or biennial (every two years) – depends on individual’s circumstances
  • basic lipid profile (total cholesterol, LDL, HDL, Triglycerides, Non-HDL Lipids)
  • CBC (complete blood count)
  • Thyroid screen (TSH, free T4, free T3)
  • CMP – complete metabolic panel (glucose, electrolytes (sodium, potassium, calcium) kidney function, liver function)
  • UA – urinalysis
  • Hemoglobin A1C for diabetics
  • PSA (annual prostate cancer screening for men)
  • Screening for Colon Cancer by checking stool for blood (both men and women)

Advanced Cardiovascular Evaluation:

  • Cholesterol and Lipoprotients: Lipid Panel, Apo B, LDL-P, HDL-P, sdLDL, APO-A, HDL2, Lp(a) mass with reflex,
  • Inflammation: MPO, LpPLA2, hsCRP, Fibrinogen,
  • Heart Function & Myocardial Stress: NT-ProBNP, Gallectin-3
  • Genetics, Platelets & Blood Clotting: ApoE, CYP2C19 (Plavix Test), Factor V Leiden, Prothrombin Mutation, MTHFR (folic acid conversion to L-methylfolate)
  • Aspirin Works
  • Metabolic: Insulin, Free Fatty Acid, Glucose, HbA1C, Vitamin D, Vitamin B12, Folate, Uric Acid, Homocysteine, Leptin, Adiponectin, Fructosamine
  • Kidney Function: Cystatin C, Glomerular Filtration Rate
  • Sterols
  • Diabetes Prevention & Management PanelLipid Particle Concentration and Size
  • Glycemic Control
  • Glucose, HbA1C, Estimated Average Glucose, Fructosamine, Glycation Gap, Postprandial Glucose Index
  • Insulin Resistance
  • Leptin, Leptin/BMI Ratio, Adiponectin, Free Fatty Acid, Ferritin, alpha-hydroxybutyrate, Oleic Acid, Linoleoyl-G-PC, IR Score, HOMA-IR
  • Beta Cell Function
  • Insulin, Proinsulin, C-peptide, Proinsulin/C-peptide Ratio, Anti-GAD
  • HS-Omega-3 Index (RBC EPA+DHA)
  • ECDT – Lung Cancer Screening (for smokers and those over 50 years of age)
  • Celiac Panel
  • SLCO1B1 Genotype (Statin Myopathy)
  • Male Hormone Panel – Testosterone (total and free), SHBG, DHEA, Estradiol
  • Female Hormone Panel – Estradiol, Progesterone, FSH, LH, Testosterone, DHEA

 

The test/s that are not recommended or not relevant will be left off. There is no reason to run tests that are not needed.
For those who choose the Member Plus option of the Annual Wellness Evaluation for $770, you will receive the additional test:

  • Brain Stem Testing ($300)
  • Additional screenings (upon availability)

 

Pricing for Advanced Cardiovascular and Metabolic Testing:

  • For those who are private pay without insurance you will need to refer to the fee schedule ( www.accessmedhome.com/fee-schedule ) for the additional fee.
  • For those who have any form of insurance there is no out of pocket cost. The lab will bill your insurance only. Medicaid does not qualify because they require the PCP (Primary Care Physician) to order the test. I no longer participate with Medicaid, so the government will not let me be a Medicaid patient’s PCP any longer.

MEDICARE:

  • The entire cost of services performed by the performing lab is covered.

PPO’s, POS & HMO Plans:

  • Performing lab will accept the amount your insurance company allows for each diagnostic.
  • In other words, your “out-of-pocket” cost is ZERO for initial and follow-up testing.
  • The performing lab takes all the risk if your insurance company does not pay for the ordered diagnostics.

 

Fees:

We believe that insurance companies and HMO’s often get in the way of quality healthcare.  Our office does not file insurance of any type.  Our fees have been dramatically reduced to make our services affordable even without using insurance.  We offer these reduced fees while providing excellent service and top quality medical care.  Our fee schedule will be beneficial for those in our community who are unable to afford health insurance and will also be appealing to those who have insurance but do not want to wait long periods of time to be seen by a doctor on their insurance plan.  It will also be helpful for those with high deductibles.

Our goal is to make it easy for those in our community to access quality healthcare without the hassle and drawbacks to managed care.  We do not sign contracts with insurance companies or HMO’s that cause us to have the insurance companies’ interests ahead of our patients. At Access Medical Home you are our # 1 priority – not your insurance company or the government.  Unlike most offices that take insurance and send your personal health information to the insurance company, we do not.  Your health information never leaves our office without your expressed request to do so (unless requested by legal authorities). Although existing patients who are members have access to same day or walk-in appointments for visits, new patients are taken on a limited basis and it may take several weeks for a new patient to become established at the practice with their first visit.

 

Lab work: We offer a significant discount for our patients regardless of insurance- this can be as much as 80% off standard LAB prices.

Other services and supplies such as strep test, stitches, and braces would be an additional but reasonable charge

 

Access Medical Home Memberships – can be purchased for 1 year (12 months) contract in two ways:

#1 – purchase of an Annual Comprehensive Evaluation for a fee of $770 for the Member Plus option, and $530 for the Member option (in office cash price) per year you can receive comprehensive physical screening exam and wellness screening that includes an extensive panel of blood work that can help identify some types of cancer, diabetes, thyroid disease, high cholesterol, leukemia, anemia, kidney or liver disease, and other diseases that may not have symptoms, but when caught early can result in better health.

 

#2 – a subscription of $59 per month for the Member Plus option, or $39 per month for the Member option for a 12 month contract that can be renewed yearly.

 

With the purchase of the Annual Wellness Evaluation, or subscription to the 12 month Membership you become an “Access Medical Home Member,” which will allow you to be scheduled for visits for a fee of – only $10 for the Member Plus option or $20 for the Member option each visit for a period of 12 months. There is no extra charge for most basic lab work for people with a membership. Some non-routine lab work that is sent out is a fee based on deep discounts. All Access Medical Home Memberships are nonrefundable once an office visit or lab work has been completed. These memberships represent a private 1 year contract between Access Medical Home and the patient, which is executed after payment has been made and initial services rendered.

 

Some insurance companies will reimburse for your annual exam. Access Medical Home Memberships are not a type of insurance, they are only a type of prepaid discount plan.  Some insurers will reimburse patients directly for any claims they submit for services such as office visits.  Access Medical Home makes no guarantees regarding reimbursement by insurance companies and does not file insurance claims or sign insurance contracts.  Medicare and Medicaid patients are not allowed to file claims, and additionally – we do not charge those patients for any covered services.

 

As a direct care clinic we do not file insurance claims. You instead pay the clinic directly for your services and you can choose to file a claim to get reimbursed if your insurance policy considers the services you received as a part of their out of network benefits.  This is a simple process of you mailing a form to your insurance company of your information that we can print for you. We do the majority of our lab testing through two different laboratories. We can use both to help you save money. If you have a health insurance policy the specialty lab will not charge you. They will only charge your insurance company. If you do not have insurance you can still use the specialty lab – see their charges listed at www.AccessMedHome.com/fee-schedule. If you need to use the other laboratory for testing then you still have the option for them to file a claim to your insurance for you, but it may be cheaper in some cases to pay for the testing directly through Access Medical Home. We cannot determine for you what your cost will be if you have the laboratory file a claim to your insurance. However, we can tell you exactly what the cost is if you pay for the testing through Access Medical Home.

 

If you choose NOT to become a member, and you choose the add-on service (Advanced Cardiovascular/Metabolic/Pre-Diabetes Education) there are two separate but related charges. You would not want to select Advanced Cardiovascular and Metabolic/Pre-Diabetes Education, if you are not planning to have the actual advanced lab testing performed. The first charge is to the clinic. It is an additional annual overhead fee of $120 to cover the cost of all the educational resources and materials including the electronic educational system. This $120 fee covers all educational services associated with the maintenance of the advanced testing regardless of how many times testing is performed in that 12 month period. The second charge only applies if you do not have insurance (or you have insurance but choose for the lab not to file a claim) – if either are the case you then will be required to pay the specialty lab’s fee for the extensive panel of advanced testing – see www.AccessMedHome.com/fee-schedule – scroll to the bottom and look for Specialty Laboratory for the amount listed for “Baseline Panel.” This amount is subject to change at any time, and you would need to check for the most up-to-date pricing before purchase. There are some items from the panel that can be removed to decrease the cost by up to $91.

 

Member Registration

 

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 Finish Point 2

Food Insurance Analogy

 

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