Membership FAQs

I have insurance through my job, and could go find a different in-network doctor for only a $30 copay. Why would I pay $99 a month to continue with you?
 
It's simple. If you believe:
 
·       We have a fantastic doctor-patient relationship

·       Our personalities mesh

·       You're comfortable being yourself here

·       My areas of expertise apply to your situation

·       I'm easy to get in touch with, friendly, and I communicate with empathy

 
Then the value speaks for itself and the answer is obvious. You should join. 
 
It is extremely difficult to find a physician anywhere who meets the above criteria. Also keep in mind that this investment is less than a cable bill, a gym membership, or what many spend on Starbucks each month – and that your health is a priority.
 
Sure, you can get a rushed fast-food meal at Taco Bell for $1.98. But wouldn't you rather enjoy an exceptional meal at your local 12-seat restaurant where you are well-known, warmly welcomed, treated like a person and not a number, and the food is healthy and delicious? Especially if that restaurant was affordable? It's all about value and the long-term relationship.
 
Another way to think about it – imagine you really love your apartment. Ideal location, quiet neighbors, friendly landlord, a place you want to call home for the long-term. If the rent goes up $99 a month, would you move out? Probably not. In New York City, finding a great physician is even harder than finding a great apartment!

 

I’m quite healthy and don’t go to the doctor often. Will I benefit from membership even if I don’t require frequent medical attention? 

Yes – you will benefit. Even if you don't require frequent medical attention, membership is a smart idea.

Unfortunately, health issues are unpredictable, and at some point you will be sick or injured and need acute care. Now more than ever, it is essential to have a doctor who knows you as a person, and who will advocate for you. I will provide first-class care and also do my best to protect you from the perils of the rampant overtreatment and excessive intervention that characterize so much of modern medicine.  

Our office is a place when you can feel comfortable being yourself, and be honest about achieving your wellness goals, which may range from weight loss to HIV prevention. We can create custom wellness plans, with built-in accountability checkpoints to help you reach your goals. Do you want to run the New York City Marathon next year? The Brooklyn Half? Cut back on drinking? Lose weight? I'll work with you to create a custom plan that will yield results.

The core philosophy is a back-to-basics approach, emphasizing a healthy lifestyle, diet, and exercise. No nonsense. I'll remain a voice of reason in the age of information (and misinformation) overload.

If we can save you just one trip to the ER over the next two or three years – then just a single year of membership will pay for itself.

 

I understand your services will be out-of-network. So how will I pay for my medications (e.g. Trvuda PrEP) and blood tests, again?

You will use your insurance to pay for your medications (e.g. Truvada PrEP, etc.) and bloods/urine/swab tests – just as you do now.

For example, your bloods will be drawn (and/or other urine/swab tests done) and sent to the lab (e.g. Quest or Labcorp). The lab will charge your insurance company, and your insurance company will pay the bill.

Regarding medications – I will write/electronically prescribe the prescription, and it will be filled by your pharmacy. The pharmacy will charge your insurance company, and your insurance company will pay the bill. 

 

Which type of health insurance would be reasonable to pair with membership? Can I adjust my health insurance plan so it works better with the DPC model? And save me money?

It is now open enrollment season, and many patients are tweaking their health insurance plan to one with a higher deductible and lower monthly premium – and using these savings to offset the membership fee. Others are looking at HSA/FSA options. If you are buying insurance on the exchange, a low-priced Catastrophic or High Deductible may be a great idea, depending on your situation. 

Your health insurance (which you need and should continue to have) should be used how it was originally intended: for expensive items, like medications, laboratory studies, blood tests, vaccines, imaging, specialist fees, emergency room visits, surgeries, and procedures.

At this point in my career, I believe health insurance companies and their perverse incentives should not play a role in the delivery of routine primary care.

 

Is the Direct Primary Care model the same as Concierge Medicine, or One Medical?

No way. Our Direct Primary Care model is affordable for everyone.  We are not a Concierge practice. Concierge practices indeed certainly exist in NYC. The fee can be thousands of dollars a month

Practices like One Medical charge an annual membership fee, but they still bill insurance (in-network) and are a large company with a group practice model. This unfortunately means you are still subject to the toxic problems of insurance companies controlling your primary care. And it will be challenging to develop a long-term, meaningful relationship with your doctor, as it's a large company with the usual staff turnover. 

 

Is there national support for this model? And what is Health 3.0?

The American Academy of Family Physicians supports this innovative new model as an alternative to the broken fee-for-service system. Click here to read more.

For most of human history, personalized care was prized and the doctor-patient relationship was paramount (Health 1.0). In the current world, science and technology have enabled wonderful advances, but the system has become industrial, commoditized, and the human touch has been lost (Health 2.0).

There is an emerging national conversation about a hopeful vision for the future – Health 3.0. The paradigm is to reintroduce the all-important humanism in medicine and combine this meaningfully with the wondrous scientific and technological advances that are now available.  

 

If I move out of town, can you still be my doctor?

With the new practice model, I can continue to be your doctor whether you relocate to Los Angeles, Lagos, or London – if you'll pass through NYC once in a while. We will remain extraordinarily accessible and available to you, and optimize emerging tech solutions to provide you with the most convenient and efficient care possible. Ultimately, some care must be provided in-person, so we must be realistic about expectations.

 

What about innovative tech solutions?

The new membership model will optimize emerging tech solutions to deliver the most convenient and efficient care possible.

That being said, our main focus is the essential human element that is at the heart of the doctor-patient relationship. Technology can be liberating, but at the end of the day, a person is not an algorithm.  

Along with Sophia and Stephanie, our spectacular office staff, we’ll continue to help you navigate the red tape and administrative absurdities plaguing the rest of the health care system. 

 

Can I skip the membership fee and just pay to come in once a year, or when I need to?

No. The monthly fee structure reflects the value of an ongoing and meaningful relationship, as the nature of our practice is not just simply transactional (like a visit to the dermatologist’s office, for example). Our practice is person-focused, not problem-focused. If you decline to enroll, I will no longer be your physician after December 31, 2017.

 

What if I decide to cancel my membership? Can I re-enroll later?

We expect to have a straightforward, honest, and respectful relationship with you. There is no minimum commitment beyond two months. We ask that you give us 30 days' notice if you wish to cancel. If you choose to re-enroll down the road, and the practice is full, you will be placed on a waiting list for new patients. The re-enrollment fee will be $399. 

 

Will you accept health insurance for your services?

No. Our office will be out-of-network, and we will not submit claims to your insurance company for our physician services. The Direct Primary Care model liberates us from corporate health care’s nonsensical, opaque, impersonal, and expensive approach to primary care – and allows us to provide you the convenient and phenomenal care that you want and deserve.

Your health insurance (which you need and should continue to have) should be used how it was originally intended: for expensive items, like medications, laboratory studies, blood tests, vaccines, imaging, specialist fees, emergency room visits, surgeries, and procedures.

 

Will I still need health insurance?

Yes. This membership is not insurance, and you should maintain insurance. We recommend a high-deductible plan, which may be offered through your job, the NY State of Health exchange, or a broker.

Many patients are savings hundreds of dollars a month by choosing a plan with a lower monthly premium. They are applying these savings towards membership with our practice.

 

Is my membership fee tax deductible?  What about FSAs (Flex Spending Accounts) and HSAs?

There is currently a lack of clarity in the tax code about how Direct Primary Care (DPC) agreements should be treated vis-à-vis Flexible Spending Accounts (FSAs) or Health Savings Accounts (HSAs) . The Affordable Care Act clearly recognizes Direct Primary Care as a delivery reform, and that it is not insurance. The NY State Department of Insurance recognizes that this retainer model with prepaid services is not insurance. Your membership fee includes the cost of an annual physical exam, and around the country individuals are using their FSA/HSA dollars to pay for this (as prepaid fees for a qualified medical service). However, keep in mind that any dispute (audit disagreement) would be between you and the IRS, you are bearing the legal risk, and you should consult with a tax professional for up-to-date clarification. FSA/HSA dollars may be used for any copays, medical acupuncture, and other qualified medical expenses. This whole issue should be clarified soon, in light of the Affordable Care Act’s promotion of DPC, and pending bipartisan federal legislation (HR 365: Primary Care Enhancement Act). Direct Primary Care is one thing that both parties agree on, so we’re hopeful. 

An option to consider for FSA/HSA use is to pay your Annual Membership Fee (which includes your Annual Physical) in full in January, and then come in for the appointment itself soon after. An Annual Physical exam is a qualified medical expense for FSA/HSA funds. Once the Annual Physical has been provided, you will be provided paperwork for FSA/HSA processing.

 

Why is there a copay for in-office visits?

NY State Law requires that a membership model practice must charge an additional fee (copay) for care related to fortuitous events.

This copay does not apply to your Annual Physical, however.

Basically, there must be a $30 copay for any in-office doctor's visit that is not your Annual Physical.

 

Is there a limit to the number of in-office visits per year?

After 16 in-office visits per year, we must charge a higher copay for in-office visits. This is in accordance with NY State Department of Insurance regulations. Click Enroll Now and see the Member Contract for more information.

 

What about medical acupuncture?

In-office visits for acupuncture will be subject to a higher copay. Click Enroll Now and see the Member Contract for more information.

 

I am uninsured. Can you still be my doctor?

Yes. But we strongly recommend you maintain health insurance.

 

How are membership fees paid?

The credit card or bank account provided at enrollment will be charged automatically each month.

 

Can you refer me to specialists?

PPO and EPO plans (carried by the vast majority of our patients) do not usually require that a referral be processed by an in-network doctor. Some HMOs have strict network requirements, and may not accept a referral from our out-of-network practice. You should check with your insurance company for more information.

 

What is your policy on controlled substances?

Abuse and diversion of controlled substances is a serious problem. We have a general policy of not prescribing controlled substances. These include, but are not limited to: Ambien (zolpidem), Adderall, Vyvanse, Ritalin, Focalin, Concerta, Valium (diazepam), Klonopin (clonazepam), Xanax (alprazolam), Ativan (lorazepam), Lunesta, Halcion, Tramadol, Percocet, Vicodin, Methadone, Oxycodone, Oxycontin, Soma, anabolic steroids, and so on.