Specific facts for Dr. Ashmore's new Community Supported Healthcare initiative:
Q: Why is Dr. Ashmore forming a CSH?
A: Dr. Ashmore insists on upholding the values that are important to your health and wellness. Spending the time in the exam room with her patients to form the doctor-patient relationship that is necessary to understand your healthcare needs is just not possible under the current insurance system of 10-15 minute rushed visits. It is this doctor-patient relationship that allows the focus to be on prevention rather than the insurance system that forces the focus to be on illness treatment.
Q: Is this a new type of Primary Care?
A: Yes and No – Yes, in that this type of practice model is forming and thriving in various areas around the country; No, in that you receive the same type of healthcare as before; although with the focus on you and not on the system.
Q: What is the membership fee?
A: There is a $900 annual membership fee to join for which you receive a number of office visits and benefits. Please click here to read the sign up form where the details of membership are outlined.
Q: Can I make monthly payments to join?
A: Yes, as the membership form offers and just like regular cable, internet, telephone, and other bills, we can debit your credit card or checking account each month. There are no additional fees for monthly debits.
Q: Will my health insurance cover the CSH membership fee?
A: Dr. Ashmore will be considered a non-participating or out of network provider with your health insurer. You will need to check with them to determine what portion of each used visit they will cover so that you can determine how much you will be reimbursed.
Q: How do I submit claims to my insurer to seek reimbursement?
A: At the end of each visit, we will print you a standard HCFA-1500 insurance claim form for you to mail directly to your insurer. Your insurer will reimburse you directly in accordance with your policy with them.
Q: Will my CSH membership fee be tax deductible or eligible for an employer’s medical flex or HSA account?
A: Each individual’s tax or employment situation is different. Please check with your tax advisor or employer.
Q: I have a high deductible health insurance policy, does this help me financially?
A: It may, many people have chosen a high deductible catastrophic health insurance policy because the premiums are quite affordable.
Q: Will my external hospital visits, lab test, referrals be covered by my insurance?
A: Yes. If you are required to select a participating PCP (Primary Care Physician) with your insurance company, you will be selecting another physician in our company to coordinate your care; however, you will continue to see Dr. Ashmore for any visits.
Q: Will there be a long wait to make an appointment?
A: NO! We anticipate same day or next day availability.
Q: Can other family members be discounted?
A: Each person in a household 18 years of age or older may join at the standard $900 annual membership fee; however, for household members under 18 years of age of a paying adult we waive the $900 membership fee and charge only $25 per office visit.
Q: I only see Dr. Ashmore for my physical and see other physicians for everything else. Can I just pay cash for the physical and not join the CSH?
A: Yes. The cash charge for her Comprehensive Executive Physical is $350; however, any follow up or other health needs would have to be handled by another Primary Care Physician in this office so that proper coordination of care can occur. Additionally, prescheduled cash physicals are not allowed to maintain availability for CSH members. You will need to call in the morning to see if there is an open slot that day.
Q: What if I join and later find another physician in the area?
A: The $900 membership fee is non-refundable. We will pro-rate a refund only upon proof that a member has moved out of the general area that Pen-Bay Medical Center serves.
Q: I still don’t understand completely, who can I contact to learn more?
A: Midcoast Medicine’s Practice Manager, Chris McIntosh, is well versed in the concept of the CSH and can answer all your questions. Please contact him anytime at (207) 236-2169.
We are also holding Town Hall meetings in small groups to meet Dr. Ashmore and discuss the concept of CSH and how it might work for you. Please call if interested, there are limited times available.
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