Iím not sure I understand how a retainer practice works.  Can you describe the model?
Dr. Okenís restructured practice is a small, independent, solo internal medicine practice, which is characterized by a direct, financial relationship between the physician and the patient and takes health insurance out of the equation.  This will help restore the doctor-patient relationship of the past, unencumbered by insurance company policies and provider-network constraints.  Dr. Oken does not participate with any insurance plans, including Medicare.  An annual professional fee is assessed to each patient.

Is this a type of medical insurance plan? 
No.  This is simply a medical practice model that will allow you to see Dr. Oken without the restrictions and complications often associated with insurance companies.

Do I still need my medical insurance if I join?
Yes.  This is not meant to replace your health insurance and you should keep your private insurance.  You will need it to help cover the cost of specialist visits, hospitalizations, labs, x-rays and other fees that typically arise outside of Dr. Okenís office and to help cover the cost of medical services provided by Dr. Okenís practice outside of the annual professional fee (where permitted).

Does it matter what kind of medical insurance I have?
No.  Dr. Oken does not participate with any insurance.

Iím covered by Medicare.  Can I see Dr. Oken?
Yes.  Dr Oken has opted out of Medicare, which means that he does not participate in Medicareís programs.  This does NOT mean that he cannot care for Medicare patients, nor does it mean that Medicare patients must forfeit their coverage by Medicare.  It means that neither he, nor Medicare patients, may bill Medicare for any portion of the professional fee or any other related expenses.  Medicare patients sign a private contract acknowledging that they agree to a private relationship with Dr. Oken.  The patientís Medicare coverage still applies to other doctors, hospitals and Medicare-covered services.

I am covered by an HMO.  Can I see Dr. Oken?
Yes.  However, if you belong to an HMO, a doctor in that HMOís network must act as your Primary Care Provider (PCP) for required approvals and referrals.  You may still join as long as you understand that for the purposes of your HMO, Dr. Oken cannot act as your PCP, nor will they cover the cost of the professional fee.
Further, invoices cannot be submitted to your HMO for reimbursement.

I am in a Preferred Provider Organization (PPO).  Can I see Dr. Oken?
Yes.  While you will be responsible for the annual professional fee, you may be able to submit bills to your insurance company for reimbursement.  Since Dr. Oken is not affiliated with any insurance companies, any reimbursement is appropriately yours to keep.  For insurance purposes, Dr. Oken is considered an ďout of networkĒ physician.  Reimbursement levels are determined by your particular policy and may be subject to an annual deductible.

How do I submit to my insurance provider for possible reimbursement?
At each appointment, you will be given an itemized invoice for all services rendered which represents the reasonable value of the services provided.  If your insurance company permits it, you can then submit a claim to your insurance company for possible reimbursement after you have met any out-of-network deductible.

If I receive any reimbursement from my insurance company, who does it belong to?
Any reimbursement received from your insurance company belongs to you since your annual fee covers the cost of the services provided (as defined by the Option you choose).

I have a Flexible Spending Account (FSA) or Medical Expense Flexible Savings Account (Medical FSA) through my employer.  Can I access it for any reimbursements?
Possibly yes, but check with your plan administrator.  Further, you may receive some reimbursement for services received that are not covered by your insurance plan.

Can I use HSA money to cover the annual professional fee?
Possibly yes, but check with your accountant first.  Further, you may receive some reimbursement for services received that are not covered by your insurance plan.

I have a Health Reimbursement Account (HRA).  Can I access it for reimbursements?
Possibly yes but check with your plan administrator.  You may receive some reimbursement for services received that are not covered by your insurance plan.

Will Dr. Oken make house calls?
Yes.  Dr. Oken will continue to make house calls when he believes it is not practical or possible for the patient to be seen in the office and when hospital evaluation and tests are not necessary.  When Dr. Oken believes a house call is appropriate, it is included in the annual professional fee as a visit.

How can I reach Dr. Oken?
Dr. Oken is available to his patients 24 hours a day, 7 days a week, with the exception of vacations and unexpected emergencies.  There is no answering service.  For routine or non-urgent matters, you have the option of calling the office or sending an email or fax.  If you need to speak with Dr. Oken regarding an urgent matter, you may contact him at the office during office hours or directly by cell phone after hours.  If he is not able to take your call immediately, he will contact you as quickly as possible, usually within 10-15 minutes.

What happens when Dr. Oken is away on vacation or unavailable?
Dr. Oken will make arrangements with an experienced Board-Certified Internist to provide outpatient coverage during infrequent times of unavailability.  These professionals are as accommodating as possible.  Every attempt will be made so that patients admitted to Howard County General Hospital are cared for by the qualified covering physician.

Can members of my family who are not current patients of Dr. Oken join?
Yes, assuming there is space available.  They can either stop by the office to fill out the forms or request further information by email.

What happens if I move away or have to leave the practice?  Will I be reimbursed some portion of the annual professional fee?
Yes.  If you need to leave the practice for any reason, you will be reimbursed on a pro-rated basis based on whole months remaining in the contract year.  If you have already received your Annual Physical Examination for the year, then $300 will be deducted from any pro-rated refund owed to you.

So is this type of practice right for me?
Maybe.  The fact of the matter is, this type of practice evolved in response to the failure of the traditional medical practice.  In summary, what it comes down to is the question you have to ask yourself:  how important is your health?  If itís high on the list of things that matter in your life, then this practice may be a good fit for you.  If you want to sit down with your doctor and discuss things that are of vital importance to you without being rushed, then this is the kind of practice for you.  The fee may seem high to some, but in most instances, it is less than the cost of your cable bill; the affordability is relative to whatís important for each individual.   Therefore, itís a personal decision that only you can make.

How can I obtain further information?
If you have any further questions, please send an email to DrOkenInfo@gmail.com.

 
   
 

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