Frequently asked questions
Insurance and Payment
Schuster Family Medicine welcomes all patients – no matter what kind of insurance they have and even those with no insurance. Schuster Family Medicine will not bill insurance, but you can use an HSA or FSA for the membership fee if you wish. If you have private insurance, you may submit a claim form to your insurance company to be reimbursed directly. The amount of reimbursement you receive will depend on your policy with your insurance company.
We like to say everything done within the walls of or by the practice is covered by the membership. If you need to go outside the office – like for labs, blood work, or specialists you can use insurance like you normally would. Dr. Schuster retains full referral capabilities and can actually offer cheap cash pricing for those with high deductibles helping you drastically reduce healthcare costs.
Click here to find out why this model is different.
Medicare offers a low baseline of primary services and typically makes it hard to gain access to a primary care physician. Schuster Family Medicine is excellent for the Medicare patient who values having unlimited access to a primary care physician that knows them. Our Medicare patients pay our practice fees directly, but Medicare coverage remains in place for everything else: specialists, testing performed outside of our office, and hospitalizations. Your Medicare will also cover labs services we prescribe as these are performed by an independent lab affiliate. Dr. Schuster can still refer, write prescriptions, and fully act as your primary care physician.
Our fees are compliant with health savings (HSAs), flexible spending (FSAs) and health reimbursement accounts (HRAs). We are happy to provide you with an invoice and/or submit a notice to your employer if any questions arise about our programs. While a membership is a qualified medical expense, we do recommend a best practice of paying semi-annually or annually with an HSA.
Our service contract is for one year. If you are unhappy with our services OR for any reason wish to cancel your contract, you may do so with a 30-day notice. Any services already performed (i.e. preventive exams) will be itemized for payment. Any refunds will be granted after the service items are paid. All contracts are automatically renewed unless a 30-day notice is received by us not to renew.
You may pay with cash, credit or check. For convenience, we keep a credit card on file for incidentals and to make it easier for you to make monthly, quarterly, biannual or annual payments.
The only change is that I’ve partnered with resources that may save you additional money if you would like to pay cash rather than submit to insurance. For example, I’ve partnered with Labcorp, MACL, Northwest Radiology, and a prescription wholesaler for dramatically lower cash-based pricing. However, if you still would like to submit to your insurance you are welcome to do so. I can provide you with those options that allow you to make the right decision based on your situation.
We accept patients as members no matter what insurance they have or do not have. We do not bill insurance. Because of this, to your insurance, this practice will be considered “out of network”.
If you desire, we will work with you to submit claims on your own and help you get reimbursed by your insurance company. How much you get reimbursed is dependent on your specific insurance plan and carrier.
You may pay with cash, check or credit card. We request a credit card on file through our secure business vendor to enjoy a cash-free office environment. The membership is completely inclusive for in-office care including visits, and we can charge your credit card directly if you choose to do any lab work or imaging at cash prices (not through insurance).
If you are going to use your Health savings accounts—payment needs to be every 6 months or yearly.
In the traditional healthcare setting, most people are accustomed to paying the doctor through insurance on a visit to visit basis. The problem is – most primary is dialogue, and it’s hard for insurance companies to know how to reimburse a conversation. This forces doctors to have you come in the office and then charge you every time you want to speak with them or follow up. Recently, Doctors have needed to see upwards of 35+ patients a day just to keep their practices solvent.
In the DPC membership model, we are free to dialogue when, where, and how long the patient needs at no extra cost. This significantly increases the level of service and care a patient receives from their doctor. So much so, that in one study patients in a DPC membership model experienced:
- 66% Less Specialists
- 65% Less ER Visits
- 35% Less Hospitalizations
- 82% Less Surgeries
British Medical Journal, October 28th, 2013
I have chosen a membership model because it’s affordable to the patient and allows me to take care of my patients (whom I love!) in the best way I know how.
The only change is that I’ve partnered with resources that may save you additional money if you would like to pay cash rather than submit to insurance. For example, I’ve partnered with Labcorp and MACL for dramatically lower cash based pricing. However, if you still would like to submit to your insurance you are welcome to do so. I can provide you with those options that allow you to make the right decision based on your situation.
Scheduling and Communication
My practice leverages a telemedicine app that allows me to be available to you after hours. especially in emergencies. This dedicated tool allows us to securely text, facetime, and send pictures in real time.
It’s easy – schedule a visit either online or call in and come into the office to see me when your visit is actually scheduled. You and I also have the option to a televisit as an alternative for a quick checkup or if you’re sick at home and would prefer not to come in. As a member of my practice there are no additional charges to see me-ever!
You never know what the future holds for your health, so I would always suggest joining for a full membership to take advantage of my time to get ahead of any problems that may pop up. If you aren’t sure if a membership is right for you, whether it be financial, for your health, or otherwise, you can always contact me so we can sit down and I can help you work through your decision.
Because my main priority is you and I want to make sure I’m available for you while maintaining little to no wait, same day or next day visits, as well as no, rushed, 45 minute visits, I cap my patient panel at 600 patients (a traditional panel is 2000-3000 patients).
If you feel you need to go to the hospital, please call and discuss with me at any time. I can help you decide whether it’s something we can take care of or if the emergency room is necessary. As your private physician, I would like to be involved in your hospital care—whether to speak to the emergency room physician or the in-patient doctor to assist in your care. We are also happy to keep in touch with your families during your stay and help arrange for your care after you return home.
Conventional insurance-based medical practices are becoming unwieldy with more employees and time spent just on billing and collections. Insurance companies dictate the type of care doctors give, and doctors have to see 35+ patients a day to maintain their business. Many times, the cost of billing is more than the fee itself.
Direct pay allows physicians the freedom to serve patients and practice medicine the way they were trained. No billing means doctors have time to spend with patients, and patients can access the doctor when and where they need to.
Ultimately, direct pay allows for more than just a better version of what is already there. Doctors are able to redefine the frontlines of care by providing proactive and preventive care that is otherwise unavailable in the traditional system. This leads patients to experience better service while having better health – namely fewer surgeries, specialist visits, hospitalizations, and medicines.
Numerous reports show better care and cost saving throughout the United States. In North Carolina, DPC saved $1.28 million in health care claims in one year for 2000 patients. Less paperwork for doctors means more time to spend with patients as needed to manage medical conditions. More time means better access which means fewer specialist referrals, hospital admissions, and ER visits. In insurance-based medical clinics, 43% of the day is spent on needless paperwork.