Question 1

I don’t understand how a direct care practice works.  Can you explain the model?

Accepted Answer

Dr. Silverman’s restructured practice is a small, independent, solo internal medicine practice characterized by a direct financial relationship between the physician and the patient.  This model removes the health insurance company from the relationship.  The new practice will restore the doctor-patient relationship to how it should be, unencumbered by insurance company policies and constraints.  Dr. Silverman does not participate in any insurance plan, including Medicare.  An annual professional fee is assessed for each patient.

Question 2

Is this a type of medical insurance?

Accepted Answer

No. This medical practice model will allow you to see Dr. Silverman without restrictions often associated with insurance companies.

Question 3

Do I still need medical insurance if I join?

Accepted Answer

Yes. This is not meant to replace your health insurance; you should keep your current medical insurance going forward. You will still need to cover the costs associated with specialist visits, prescriptions, hospitalizations, labs, radiology, procedures, and any other medical fees which arise outside of Dr. Silverman’s office.

Question 4

Does it matter what type of medical insurance I have?

Accepted Answer

No. Dr. Silverman does not participate in any health insurance plans. Your choice of insurance may affect your ability to collect out-of-network benefits.

Question 5

I am covered by Medicare.  Can I still see Dr. Silverman?

Accepted Answer

Yes. Dr. Silverman has opted out of Medicare, which means that she does not participate in Medicare’s programs. This does not mean that she cannot care for Medicare patients, nor does it mean that any Medicare patient must forfeit their Medicare coverage. It only means that she cannot bill Medicare for any portion of the professional fee or any related expenses. The patient will need to sign a private contract acknowledging that they agree to a private relationship with Dr. Silverman. The patient will still be able to use their Medicare coverage for any other Medicare-covered service.

It should be made clear that Medicare patients will not be able to file any claims to Medicare for Dr. Silverman’s services. Patients who may have a secondary insurance, please contact that payer to determine out-of-network benefits.

Question 6

I am covered by an HMO.  Can I see Dr. Silverman?

Accepted Answer

Yes. However, if you belong to an HMO, a doctor in that HMO’s network must act as your Primary care Provider (PCP) for required approvals and referrals. You may still join the practice if you understand that for the purposes of your HMO, Dr. Silverman cannot act as your PCP for referrals and other insurance requirements, nor can you submit invoices to the HMO for services provided by Dr. Silverman.

Question 7

I am in a Preferred Provider Organization (PPO).  Can I see Dr. Silverman?

Accepted Answer

Yes. While you will be responsible for the annual professional fee, you may be able to submit bills to your insurance company for reimbursement, dependent on the individual’s plan benefits. Dr. Silverman does not participate in any insurance company’s plans; therefore, any reimbursement would be yours to keep. For insurance purposes, Dr. Silverman is considered an “out of network” physician. You are responsible for submitting any bills for out-of-network reimbursements.

Question 8

How do I submit to my insurance provider for possible reimbursement?

Accepted Answer

At each appointment, you will be given an itemized invoice for all services rendered, representing the reasonable value of the services provided. If your insurance company permits, you can submit an out-of-network claim to your insurance company for possible reimbursement. Reimbursement amounts vary depending on your specific insurance plan. Your insurance company should be able to provide you with additional details. Any reimbursement received belongs to you.

Question 9

I have a Flexible Spending Account (FSA) or a Medical Expense Flexible Savings Account (Medical FSA) through my employer.  Can I access it for reimbursements?

Accepted Answer

Possibly yes. You will need to check with your plan administrator for details.

Question 10

Can I use Health Savings Account (HSA) money to cover the annual professional fee?

Accepted Answer

Yes. You should check with your accountant about the current regulations on this topic.

Charges for medical care received by a direct care doctor are eligible for reimbursement with a flexible spending account (FSA), Health Savings Account (HSA) or a Health Reimbursement Arrangement (HRA).

Question 11

I have a Health Reimbursement Account (HRA).  Can I access it for reimbursements?

Accepted Answer

Possibly yes. You should check with your accountant for the current regulations on this topic.

Question 12

How can I reach Dr. Silverman?

Accepted Answer

Dr. Silverman is available 24 hours a day, seven days a week, with the exception of vacations or other emergencies.  For routine or non-urgent matters, you can call the office or use the online portal.  For urgent matters during normal business hours, you can call the office.  For any urgent matters outside of normal business hours, Dr. Silverman will be available by cell phone.

Question 13

What happens when Dr. Silverman is on vacation?

Accepted Answer

Dr. Silverman will make arrangements with a Board Certified Internist to provide outpatient coverage during any infrequent times of unavailability.

Question 14

Can members of my family who are not current patients of Dr. Silverman join?

Accepted Answer

Yes. Assuming space is available.

Question 15

Is this type of practice right for me?

Accepted Answer

This type of practice has developed in response to the failure of modern primary care practice.  While this question is very personal, the question is how important is your health to you?  If your health is a priority, then this type of practice would be good for you.  If you desire the ability to sit with your physician and discuss your health concerns in an unrushed caring environment, then this type of practice is right for you.  While most patients are not accustomed to paying for their primary care, this type of practice offers great value.  For a reasonable fee, you can have high-quality, compassionate health care when you need it without the hassles of lines, long waits, or insurance red tape.  The final decision is personal and individual.

Question 16

What are the fees?

Accepted Answer

Please contact our office for updated pricing.

Frequently Asked Questions

I don’t understand how a direct care practice works. Can you explain the model?

Is this a type of medical insurance?

Do I still need medical insurance if I join?

Does it matter what type of medical insurance I have?

I am covered by Medicare. Can I still see Dr. Silverman?

I am covered by an HMO. Can I see Dr. Silverman?

I am in a Preferred Provider Organization (PPO). Can I see Dr. Silverman?

How do I submit to my insurance provider for possible reimbursement?

I have a Flexible Spending Account (FSA) or a Medical Expense Flexible Savings Account (Medical FSA) through my employer. Can I access it for reimbursements?

Can I use Health Savings Account (HSA) money to cover the annual professional fee?

I have a Health Reimbursement Account (HRA). Can I access it for reimbursements?

How can I reach Dr. Silverman?

What happens when Dr. Silverman is on vacation?

Can members of my family who are not current patients of Dr. Silverman join?

Is this type of practice right for me?

What are the fees?

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