Enrollment Appendix 1

Home Enrollment Enrollment Appendix 1
APPENDIX 1

This Agreement is for ongoing primary care.  This Agreement Is  NOT HEALTH INSURANCE and is NOT A HEALTH MAINTENANCE ORGANIZATION.The Patient may need to use the care of specialists, hospitals, emergency rooms, and urgent care centers that are outside the scope of this Agreement. The Physician within the Practice will make an appropriate determination about the scope of primary care services offered by the Physician.

SCOPE OF THE PRACTICE:

(a) Examples of common conditions we treat, procedures we perform, the medications we prescribe are listed on our website and subject to change. The Practice will provide ongoing primary care services that deal with the majority of patients’ medical problems and provide preventive services that will reduce the incidence of complications of most medical problems. Physical exams, joint injections, minor surgical procedures and many in office lab studies including EKGs will be offered as part of the ongoing primary care fee.

(b) the Practice will offer routine gynecological care, Pap smears and menopausal treatments. However the Practice will not offer obstetrical care, contraception or reproductive medicine services.

(c)  the Practice will not offer routine pediatric and well-child care or pediatric immunizations to patients below the age of 18. However, if the child of one of our adult patients has an urgent need and cannot obtain timely care from their normal pediatric provider, the Practice will make every effort to accommodate that child quickly for a minimal fee assuming the schedule allows.

(d) the Practice will not be prescribing chronic prescriptions for controlled substances such as opiate pain medications for non-cancer pain. At the discretion of the Physician, short courses of such medications for acute medical problems will be considered.

(e) Acceptance of patients:  We reserve the right to accept or decline patients based on our capability to appropriately handle the patient’s primary care needs. We may decline new patients pursuant to the guidelines proffered in contract section 7 (Term), because the Physicians panel is full (capped at 400 mature adults or fewer) or because the patient requires medical care not within the Physician’s scope of services.

(f) After Hours Visits:  There is no absolute guarantee of after-hours availability. This agreement is for ongoing primary care, not emergency or urgent care. Your physician will make every reasonable effort to see you as needed after hours when your physician is available.

FEE SCHEDULE

Enrollment Fee:  this $50 fee is charged when the Patient enrolls with the Practice and is nonrefundable.

Monthly Periodic Fee: This fee is for ongoing primary care services and is billed monthly at the end of each  month of service. Twenty scheduled in person visits per year are available to you at no additional cost.  Each scheduled in person visit over twenty will be charged at a $25 per visit fee. Your number of virtual visits (email, text, electronic, phone) are not capped. We prefer that you schedule routine visits more than 24 hours in advance. Urgent problems will be seen as rapidly as possible. Most ancillary services  such as EKGs and many in office lab procedures will be passed through at no additional cost to you. Some ancillary services such as immunizations, expensive injectable medications and some tests will be billed to you at cost with no additional markup by us.

The monthly periodic fee schedule is based upon the age of the Patient:

Ages 18 to 26:    $25 per month

Ages 27 to 37:    $50 per month

Ages 38 and up: $100 per month

A fee of $35 will be charged for any urgent visit for a child under 18 years of age who is the child of a patient in the practice.

A fee of $7 will be charged for minor surgical procedures and joint injections.

Except for changing prices due to a patient changing age cohort, the schedule will not be changed more than once every 12 months, and the patient will receive 90 days notice of any planned change in price.

The monthly periodic fee will be billed at the end of each month. After an initial mandatory three-month initial period of enrollment, the Patient is entitled to leave the practice at any time. If the Patient leaves prior to the end of the month, any services received by the Patient in that time will be billed to the Patient.