Note that specific details are subject to change as we move forward.
Are you leaving medicine?
No! I have spent too many years getting to know my patients to leave. I am giving up on insurance, but not on my patients.
Will your clinic take insurance?
In order to give better regular primary care, and have enough time with patients, I will not be filing insurance claims. At the same time, I am making my fees reasonable, and I will be happy to provide any information necessary to allow patients to seek reimbursement from their insurance company., including Medicare patients who have Advantage plans.
For Coventry, click here for a link to their form.
For Blue Cross/Blue Shield, click here for the form for claim reimbursement.
(We'll add more links as we find them, or you can get them from your insurer).
How will labs, X-rays, and specialists work?
For labs, you will have the option to use my clinic's discounted lab prices or have the lab bill your insurer directly. My clinic Lab fees will be posted clearly in the office with updates as needed.
All imaging studies (Mammograms, Dexa scans) and referrals to other specialists can and will still be billed directly to your insurer by the providers of these services, but I am looking into discounted pricing for these as well, outside of insurance, if this option might be helpful. Prescriptions will also be covered by insurance, as usual.
Can you follow Medicare Patients?
Yes. I would love to continue to see my Medicare patients, but they will need to sign a waiver (as required by Medicare).
Will you take Medicare or Medicare Supplements as insurance?
No, I will not be able to file Medicare, and unfortunately, before a Medicare recipient can attend my clinic Medicare requires you to sign a waiver, stating that you will not seek any reimbursement for any of my services, because I am opting out of Medicare as of 1/1/15.
But Medicare patients with Advantage Plans may be able to seek reimbursement from their Advantage insurance providers for most services.
Why will you not be accepting Medicare as insurance?
This deserves an extra comment: not only does Medicare make a zillion rules, they are often vague or even contradictory. At the same time, if a doctor is judged (by a bureaucrat) to have not followed the rules precisely, the doctor can be fined (which I have seen with other providers) or even jailed (which I do not wish to see). There are already literally over 130,000 pages of Medicare regulations (and that was in 2001!-- click Here for link), and keeping up with them is not a good use of time.
For further information on how Medicare complicates care, click here.
Once you get past the glittery eye-shadow, this doctor's views on Medicare should be taken seriously (Click here!).
Why do I still need insurance if I'm going to your clinic?
You won't need insurance for the general medical care I provide, but everyone should keep insurance for the expensive specialists and especially for the risk of catastrophic events, like a car accident, cancer, severe infection, or other major illness.
Think of your health insurance like your car insurance. You don't want to pay the insurance company to "handle" your routine car maintenance. They would be tracking and accounting for inflating tires and oil changes. It does not save any money, because the costs are the same, yet you additionally have to pay to support the insurance auditors. You could spend $50 extra a month to "not worry" about the maintenance costs, when you only need a $19 oil change every 3-6 months. The real need for insurance is the car wreck (or heart attack).
In my clinic, by paying the doctor's fees directly to the doctor, you save the costs of the middleman.
Where is your new clinic?
We have locked in our new site at 135 Charlotte Highway, Suite E, Asheville, NC, 28803 -- virtually down the street from my current location. We plan to officially open on January 12, 2015, but will have our phones activated to accommodate pressing needs as soon as January 1, 2015, for established patients. Click here to see the Contact page for updates.
What will your hours be?
I anticipate generally maintaining regular scheduled appointment hours between 9 a.m. and 2 p.m., and will keep same-day slots available most days up to 4:30 p.m. to accommodate patients with acute issues. I look forward to having increased flexibility outside of these hours as well. I plan to make myself available for after-hours and weekend visits as needed and appropriate for all my established patients (which include Member and Fee-For-Service patients). See Pricing for details.
How will this new practice help patient care?
I'm making this change so that I can practice another 10-20 years, or more, and you can have the enormous benefit called "continuity of care." How many of us have the same doctor they had 10 years ago? It is getting more and more rare. I will continue to take the time to see you when you need to be seen, and be better able to schedule you appropriately for your needs so that you will not have to wait as long to see me.
Many problems may be able to be addressed just by phone. And in some situations, I plan to offer home visits for a surcharge. Even if every patient follows me, as I certainly wish, I will have much less wasted time spent in justifying my every effort to Third Party Payers. You will not spend your visits watching me punch the computer keyboard. We will be much more free to interact.
Will I be able to enroll in your clinic?
My current patients will all have first priority to officially enroll in my clinic as soon as January 1st, 2015, though we are already scheduling patients as soon as our door officially opens on January 12, 2015. After that, I will begin to schedule patients on the waiting list on a first-come, first-serve basis.
How do I enroll in your clinic?
There will be two ways to participate in my clinic.
Membership. For an annual fee (which I would like to have payable quarterly or in full for a discount), patients who enroll will have priority with scheduling; no charge for phone or email consultations; discounts on procedure costs; and follow up visits for the year at $20/visit; have telephone access to me after hours, and be eligible for home visits when appropriate, at my discretion.
Fee-For-Service (FFS). This is a more "traditional" model which may work better for persons who do not need to be seen more than once or twice a year, and still be cheaper than an urgent care. I generally will schedule these patients during regular hours. FFS patients may convert to full membership at any time.
How are your services priced?
Please link to the menu item on Pricing, which I will update periodically
Will there be any discounts?
I am offering discounts for couples, and children/young adults up to age 22. Patients who pay in full for the year-membership will also receive a discount.
How do I schedule an appointment or contact you as of Jan. 1 2015?
Until December 31, 2014, you can still contact Denise at 296-0880; we are keeping a book of scheduled appointments. After January 1st, you will be able to contact me via our new phone number which will be set up to take messages and, in an emergency, give you the option to have the call forwarded to my cell phone. We will look for an automated/online mechanism to schedule appointments in the future.
How will I get my refills?
Essentially the same as always. If you are enrolled as a regular member, or I have seen you in the last 6 months, then I will generally feel comfortable refilling your medicines. However, if you have a complex or unstable medical problem requiring closer monitoring and you are overdue for labs or a follow-up office visit, I may only be able to approve enough of your prescription until your labs and office visit are scheduled.
Can I see specialists?
Absolutely, although I will continue to manage those problems I feel are within my scope of normal practice. I have no disincentive at all to keep you from specialists... but the moral and monetary incentives are better aligned in Direct Patient Care to simply, always, give you the best care I can. That includes saving you time and trouble with other doctors, if it is unnecessary.
Is your clinic worth the money?
I believe it is worth it, and for as miserable as our current medical system can make patients and doctors, I truly hope more and more doctors will adopt this model of care. If a patient decides they are not satisfied with my care, I will always honor their wishes, and I will be happy to facilitate transferring care to the provider of their choice. My door will always be open for prior patients who left on good terms and wish to return.
Who will cover weekends and holidays?
At this point, I plan to make myself available, for established patients only, by phone after hours and on holidays for urgent needs. For true emergencies, please don't hesitate to proceed to the Emergency Room. In general: if any given symptom is worsening by the week, it probably can wait for a normal visit, within a business day or so. If worse by the hour, it may need emergent attention-- call me if you're really not sure. If truly worse by the minute, call 911.
I will need to work with you, my patients, to balance reasonable availability with respect for personal and family time. As nervous as some doctors are with solo practice, I have not yet been abused by my own patients, and I trust my patients to respect me as I will respect them.