WHAT WOULD YOU LIKE TO KNOW?
You’ve Got Questions - I’ve Got Answers
WHAT IS A CONCIERGE PRACTICE?
Otherwise known as “Boutique” or “Retainer-Based” Healthcare, this type of service was started in 1996 by a doctor in Seattle. Since then, there are numerous physicians practicing this style across the United States, and growing. The core concept is to provide highly personalized, accessible and attentive care to our patients. In today’s healthcare, a “typical” physician will care for over 3,000 patients. In our practice, we limit the number of patients to just a few hundred. Patients will enjoy numerous benefits not commonly seen using today’s “traditional” healthcare model. Please see Benefits.
HOW DO YOU SUPPORT SUCH A PRACTICE?
Each patient pays an annual retainer fee, based on their age, which enables the practice to limit the number of patients and provide more personalized services. PPH offers the FEE-FOR-SERVICES concierge model, which means we collect only the annual fee, and nothing else. This fee will cover all of the Internal Medicine services provided by our office, including exams, EKGs and lab draws.
HOW MUCH IS THE RETAINER FEE?
The annual retainer fee is payable in monthly installment and, varies with age. Discounts for Family Memberships and couples are available Please see Membership Info for specific amounts.
DO YOU TAKE MY INSURANCE?
No. We do not bill insurance plans, including Highmark, UPMC and Medicare. Your annual fee is all that will be required. This means no co-pays or deductibles, no bills to turn into insurance companies, no hassles and no hidden charges. We do work with your insurance company to obtain payment authorizations for testing and services you may need outside of our office.
DO I STILL NEED HEALTH INSURANCE IF I ENROLL WITH YOU?
This program does not replace your existing health insurance, which will be necessary for all expenses outside of our office, including diagnostic lab work, x-rays, hospitalizations and visits to other doctors. However, you might consider lowering your insurance premiums by carrying a higher deductible, because your insurance will not be billed utilizing our services. You are encouraged to discuss this with your healthcare consultant.
WILL MY PRIVATE INSURANCE REIMBURSE ME FOR YOUR ANNUAL FEE?
Because insurance plans vary, we cannot advise you regarding reimbursements. However, some Flexible Spending Account (FSA) and Health Savings Account (HSA) plans may pay for all or part of the annual fee. Check with your insurance plan administrator or Human Resources representative at work for clarification.
IS THE ANNUAL CONCIERGE FEE TAX DEDUCTIBLE ON MY TAXES?
Patients are advised to consult with their tax consultant to clarify qualification in their particular circumstance.
WILL YOUR PRESCIPTIONS FOR LAB WORK, X-RAYS, PHYSICAL THERAPY AND MEDICATIONS BE COVERED WITHIN MY HEALTH PLAN?
You are encouraged to verify this with your individual insurance plan, but as long as the service is billed by a participating provider, you should receive “in-network” benefits as in a traditional practice. For example, the laboratory or radiology group that performs the service will bill your insurance company for the blood work or xrays, not my office.
MY INSURANCE REQUIRES PRIOR AUTHORIZATIONS FOR CERTAIN TESTS, SUCH AS MRIS. WILL I STILL BE ABLE TO GET THESE TESTS COVERED?
Again, you are encouraged to verify this with your insurance plan, but prior authorizations will be able to be obtained. Even though I am considered “out-of-network”, I will be able to obtain prior approval from your insurance plan for these services. You are also entitled to a patient appeal process directly to your insurance company, which my office will assist you if necessary.
WHAT IF I HAVE AN EMERGENCY OR NEED HOSPITALIZATION?
If you have a life-threatening emergency, call 911. Patients are asked to contact me before going to any urgent care facility at any time of the day or night. I will make every effort to address urgent needs directly that occur after-hours. If you do go to any emergency room, I will be available 24 hours a day for consultation with emergency room personnel and for coordination of your care. Specialty referrals will be discussed with the emergency room physician if warranted.
WHAT HOSPITAL DO YOU ADMIT TO?
I am on staff at The Washington Hospital, located at 155 Wilson Avenue, Washington PA 15301. If you are admitted to this hospital, I will see you there and be your attending physician. If you are admitted to any other hospital, you will need to be admitted to the services of another doctor who has admitting privileges to that hospital. I will stay in contact with the admitting doctor regarding your care. If that hospital is within close proximity to my office, I will be able to visit you during your stay.
DO YOU CHARGE FOR HOSPITAL VISITS?
No. As stated above, your annual fee covers all of my services for you, including hospitalization visits.
CAN I SCHEDULE AN APPOINTMENT AFTER NORMAL OFFICE HOURS?
Our goal is to be available when needed, and if a patient is not able to get into our office during normal hours, we will work with them to find a mutually available time, including evenings and weekends
DO YOU MAKE HOUSE CALLS?
While we are an office-based practice, there may occasionally be a situation where a patient is unable to get to the office. In these instances, I may be available to see you in your home outside of our normal office hours. For patients that are completely home bound, I can customize a plan to meet their needs.
WHO WILL COVER FOR YOU WHEN YOU ARE NOT AVAILABLE?
When out of town, my staff and I will still be available by phone. On the infrequent occasions when I am unavailable, there will be a fully qualified physician available locally if needed. Patients will be notified in advance as to how to contact that physician if necessary.
YOUR CONTRACT INCLUDES A MEDICARE OPT OUT AGREEMENT, WHAT DOES THAT MEAN?
Premier Personal Healthcare practices the “fee-for-care” model, which requires the physician to completely Opt Out of Medicare. This means that I am agreeing not to submit any Medicare claims or receive any payments from Medicare for any services provided to you. I need to renew this every two years. If you are a beneficiary of Medicare, and joining my practice, you are required to sign these forms every two years as well. This will not change your Medicare benefits in any way as it relates to services outside of my practice. You will continue to receive Medicare coverage as before.
WHAT HAPPENS IF I MOVE OUT OF THE AREA AFTER I ENROLL?
If you must transfer your care, we will assist you in finding a new doctor. Your medical records will be promptly sent upon receipt of your Medical Release Form. The balance of your fee will be prorated and refunded.
CAN I WAIT AND JOIN LATER?
By design, my practice is a membership concierge practice with a limited enrollment. Once that enrollment limit is reached, a waiting list will be established. Every effort will be made to accommodate interested patients, but the enrollment limit must be honored in order to continue to provide the highest standard of personalized care and service to all participating patients.
HOW DO I JOIN?
We recommend that you call the office to schedule a meeting or telephone call with Dr. Plute, without charge or obligation, in order to get acquainted and review your medical history and needs. Together, we can determine if our services and approach meet your needs and expectations. We will review our membership agreement with you and answer all of your questions. If you join the practice, we recommend starting with a comprehensive physical exam to assess your baseline health status.