Tired of Corporate Healthcare? ME TOO! That is why I started Paradise Valley Internal Medicine, PLLC. For years, insurance companies have driven down reimbursement to providers, particularly in Primary Care. This has led to the need for high volume patient panels to make up for the difference. Many doctors, as a result are now employees of larger companies and cannot control the time they are able spend with their patients. This has had a deleterious effect on patient’s satisfaction and health outcomes within our healthcare system. This is why many physicians have left practices, retired, or moved outside the insurance system to “cash” practice models. Experience the difference in a practice that is 100% locally owned and operated by the Doctor providing care.

FINALLY, a more affordable concierge style practice. Paradise Valley Internal Medicine and Consulting, PLLC, is a Private, Fee for Service model, much as older practices used to be. Before you panic, or think “that will be too expensive,” let’s compare to other “Cash” or “Direct Pay” models. I do not charge “Membership Fees” or “Subscription Fees” in order to have access to the doctor. My prices are clearly listed, transparent and will be reviewed with you upfront. Consider how often you go to the doctor each year, and what you would spend using these various models. Also factor in that under this model, my charges are for physician services provided, and therefore some insurance plans will allow you to submit my bills for reimbursement as an “Out of Network Provider.” They will not reimburse you in full, but at least some partial reimbursement is better than none. (Remember, if insurance companies reimbursed physicians in full and on time, I would take insurance.)

What will paying outside of insurance do for me?

• More time with the Doctor during visits.

• Greater appointment availability, sometimes same day.

• A more personal relationship with your Doctor.

• Direct access to your records anytime from anywhere on the portal.

• Direct Messaging to the Doctor for non-urgent questions or requests through the portal.

• The ability to contact the Doctor for Urgent questions after hours.

• Tele-Health visits available to established patients.

Concierge Models: These models often charge an annual membership fee of $1500 to $5000.00 and up just for access to the office/doctor. They may also subsequently still bill your insurance for your visits. Because those charges are fees, they are usually not reimbursable by insurance plans, nor submissible to HSA accounts. I am trying to make Concierge Style Practice more affordable and available to those who want it. I do not charge an Annual Membership Fee.

Contract Models: These models also resemble Concierge Models, and charge a monthly membership fee for access to the office/doctor. These fees range from $100 to $125 per month. That is between $1200 and $1500 per year. Again, because these are fees, they are not generally reimbursable by your insurance company. I do not charge a Subscription Fee.

My rates are listed on my Fee Schedule page. Rates are for physician services or specific treatments/procedures only and DOES NOT include labs, x-rays or other radiology tests, referrals, urgent care, ER visits or hospitalizations. (yes you should still have insurance to cover these items). My “New Patient Visit” is 1 hour and is $500. The goal is for you to be able to spend time with me as your doctor. If you normally see your doctor once per year for an Annual Exam, that would be your out of pocket for physician services for the entire year. If you plan to submit the bill to your insurance, then your out of pocket cost will be reduced by what they reimburse. Requests for visits can often be handled and scheduled in the same business day.

Let’s hypothesize that you see your doctor 4 times per year (1 Annual visit, 3 follow up 30 min visits ($250 each)), that would be $1250 for the year. That is similar to the annual rate for contract models, and far cheaper than full concierge models. This estimate is also before any potential reimbursement from your insurance plan, and that makes my model significantly cheaper for you compared to the other models!

IF YOU HAVE:

Insurance: I do not accept any insurance for payment in my office, all bills will be out of pocket and is due at the time of service. I still recommend having insurance for other medical bills that are outside of my office such as labs, radiology, urgent care, ER visits, hospitalizations, specialist referrals (this list is likely not comprehensive). Even though I don’t take insurance in my office, I still collect your insurance information so that it can be submitted with orders from my office for lab work, radiology procedures, specialist referrals and therapy. You will need to pay attention to your insurance to make sure that your insurance will reimburse for out of network providers. HMO type plans likely will not as they often REQUIRE in network PCP’s, and may not even recognize orders for referrals or tests from out of network providers. PPO and open access plans generally will, but may be subject to additional “out of network deductibles.”

Medicare: I have OPTED OUT of Medicare entirely. That means that I do not take any Medicare plans, nor can I submit bills to Medicare, nor can YOU submit my bills to Medicare for reimbursement. If you have Medicare, you will need to sign a contract stating that you are aware of this. You can still use me as your PCP, but you need to understand that all costs from my office will be out of pocket with no possibility of reimbursement. Things that I order such as Labs, Referrals and Procedures WILL still be covered per Medicare guidelines.

High Deductible Plans: If you have a high deductible plan that does not include any preventive office visits or tests, then you should anticipate that most of my charges, even over the course of a year, will not meet your deductible. You should still submit my bill/note to your insurance so that you get credit for the visit on your deductible. I can work with you to decide if lab tests or procedures that you need would be better through your insurance or to review cash prices that lab companies and radiology companies may charge locally.

No Insurance: If you don’t have insurance, then my fee schedule represents the full cost, no hidden fees. If you need labs or other radiology procedures, I can work with you to review cash price options from various local lab and radiology companies.

Health Savings Accounts: I do accept payments from Health Savings Accounts (HSA/FSA). As these are “pre-tax” accounts, if you plan to submit my bill to an insurance company for reimbursement, then you should pay out of pocket first. After Submitting to your insurance company, any amount that they don’t pay you for (co-pay, deductible, amount above their allowable amount for services) you can submit to your HSA/FSA account for reimbursement. If you do not plan to submit my bill to an insurance company for reimbursement, you can use an HSA account to pay my bill directly.