Membership
Membership Fee - Questions and Answers - FAQ
- Is My Membership Fee health insurance?
- Are you on all insurance plans?
- Do I still need medical insurance?
- How can I reduce my insurance premiums?
- If I am in a managed care plan can I still be a Member?
- Will my annual fee cover visits to other Physicians for health care?
- Will my insurance plan be billed for the Annual Membership Fee?
- Will my insurance pay for outside goods or service ordered through Prime Healthcare Providers?
- Can I apply my Membership Fee to my insurance deductible?
- Can I still become a patient if Medicare covers me?
- What if I need to a specialist?
- What happens if I have an emergency?
- What if I need to be admitted to the hospital?
- Are any imaging services provided in my annual Membership Fee?
- Does my Membership Fee offer maternity care?
- Can I continue to see my gynecologist?
- Will I be notified if you add or discontinue services?
- Do I have to pay the Annual Membership Fee all at once?
- Is the annual fee tax deductible?
- Can I get a refund if I am not satisfied?
- How can I learn more?
- Is My Membership Fee health insurance?
No. We provide direct medical care, not third-party medical insurance. Your annual fee only pays only for the primary and preventive care services described in our service guide.
- Are you on all insurance plans?
No. Our physicians are currently enrolled in a variety of large insurance networks. Our office works closely with each patient to ensure proper coordination with their existing insurance plan.
Most PPO, POS and HMO health insurance plans are compatible with your membership in PMC. We will be happy to discuss your specific health plan with you. Your annual fee is for preventive care services that are generally not covered by insurance. You will still need health insurance to cover your healthcare visits that are unrelated to the comprehensive, annual preventive care examination, including office visits, hospital stays and visits to specialists.
- Do I still need medical insurance?
Yes. We require all of our patients to maintain medical insurance to safeguard against the financial burden of any unanticipated illnesses that need hospitalization or specialist attention. Additionally, patients need insurance coverage for medications and certain specialized tests.
- How can I reduce my insurance premiums?
If you have medical insurance and join my practice you may decide to switch from an HMO plan or a low-deductible PPO plan to a high-deductible PPO plan and use the savings in insurance premium to help pay for the practice membership fee. A high-deductible insurance plan is truly for catastrophic healthcare, as insurance was originally meant to be. Compare this to automobile insurance, which you similarly hope to never need for the car for which you pay separately as needed for routine servicing (equivalent to a preventive care visit) and for mechanical problems (equivalent to an office visit for an acute illness). By not paying an HMO to manage your healthcare dollars you instead get to decide how you want to spend (or NOT spend) your healthcare dollars.
- If I am in a managed care plan can I still join?
Yes. Regardless of what insurance or managed care provider plan you may have, your annual membership fee provides you with the services of a Prime Healthcare Providers Physician. However, you should know that your managed care company or your health maintenance organization (HMO) may refuse to pay for any goods or services that are not ordered by one of their contracted providers. You should check with your insurance or managed care provider plan before becoming a Prime Healthcare Providers patient.
- Will my annual fee cover visits to other Physicians for health care?
No. We are not an insurance company, so your annual fee does not include, or cover, any goods or services you receive outside of our offices.
- Will my insurance plan be billed for the annual membership fee?
No. Prime Healthcare Providers does not bill insurance carriers for the annual membership fee. However, your insurance plan will be billed for other usual and customary medical services provided by our doctors in your usual day to day medical care as described in your insurance policy under covered services.
The annual membership fee is not reimbursable by any health insurance company, nor are they reimbursable by Medicare or Medicaid.
If you have "Cafeteria Plan" coverage through their employer, Flexible Spending Account (FSA), Health Savings Account (HSA), Health Reimbursement Account (HRA) or Medical Savings Account (MSA) your annual fee may be eligible for reimbursement. However, they will not likely count towards any annual deductible. Please check with your plan administrator.
We can provide you with a statement for your benefits administrator at any time. It is important to note that while this fee is reimbursable through your FSA, you cannot pay the fee with your FSA debit or credit card. Reimbursement for your annual fee will have to be obtained through your FSA claim submission process. Your annual physical must be performed during your FSA plan year to be eligible for reimbursement. For example, if your FSA account year runs from January 1, 2013 through December 31, 2013, you must have your annual physical during the 2013 calendar year.
For more information you can download and print the brochure Health Savings Accounts at a Glance from the American Medical Association website. The IRS provides detailed information about HSA's on their website.
In addition, the cost of your annual membership fee is fully IRS tax-deductible (see "Medical Services" on page 12 of the IRS Publication 502 - Medical & Dental Expenses).
- Will my insurance pay for outside goods or service ordered through Prime Healthcare Providers?
Yes. Most insurers will pay for medical goods and services covered by their plan regardless of the ordering medical provider. However, you should check with your insurance carrier to make sure. If you are a member of an HMO, your plan may refuse to cover any services ordered by a Prime Healthcare Providers Physician if he is not in their network.
- Can I apply my annual membership fee to my insurance deductible?
No. Only an insurance carrier can determine which expenses are counter against their plans’ deductibles. The annual fee is not an expense that can be applied to an insurance plan deductible. However, it may be used as a tax deduction.
- Can I still become a patient if I am covered by Medicare?
Yes. We are compatible with Medicare. However, we want you to know that our annual membership fee is not reimbursable by Medicare as it covers those services not reimbursed by Medicare. Medicare Part B will pay only for covered medical and surgical services provided by a Medicare contracted provider. Because we do participate in Medicare your office visits and services for usual and customary care are reimbursable from Medicare. If you need outside services such as laboratory tests, specialty care or imaging services, we will refer you to a Medicare contracted provider whenever possible.
We do not participate with Medicare Advantage plans
- What if I need to a specialist?
It is our goal is to accommodate and provide service for as many of your health care needs as we can. However, when your medical needs are beyond the scope of our primary care services, we will refer you to an appropriate trusted specialist in our network and provide, as must assistance as possible. We can provide that specialist with your relevant medical record and the information needed to optimize your care. When his or her evaluation is completed, we will assist you with the follow-up and coordination of your specialty care needs. However, you will be responsible for paying for any of these outside services. If you have insurance, we recommend that you check with your insurance carrier to determine what will be covered.
- What happens if I have an emergency?
If you have a life threatening medical emergency, you should call 911 immediately. Prime Healthcare Providers is not equipped to care for someone experiencing a life-threatening emergency.
For urgent, non-life threatening medical problems, you may call the office to speak with a physician on call 24 hours a day, 7 days a week. If you need to be seen during office hours, we will get you in as quickly as possible, usually on the same or next day. If your medical provider determines that you need emergency care, we will refer you to the nearest emergency room. Before your arrival, we will call the emergency room to let them know you are coming and give them your medical information. After you have been evaluated, we will confer with the emergency room physician to discuss your care and assist with any follow-ups needed.
Please note that your annual membership fee does not cover ambulance, emergency room or other hospital services. If you have insurance, we recommend that you check with your insurance carrier to determine what will be covered. If you are uninsured, you may want to discuss payment options with the financial services coordinator at the hospital emergency department.
- What if I need to be admitted to the hospital?
If you need to be admitted to the hospital, your Prime Healthcare Provider Physician will refer you to an appropriate hospital and coordinate your admission.
When you become a Prime Healthcare Providers patient, you can designate a preferred hospital or we can help you choose a hospital based on where you live or work and the services you might need.
Your Prime Healthcare Providers medical team will maintain telephone contact with the attending physician caring for you at the hospital and will provide any necessary records and information to such physician. When you are ready to be discharged, your Prime Healthcare Providers medical team will talk with your attending physician to coordinate appropriate follow-up care.
Your annual membership fee does not cover any costs associated with your hospitalization, except the coordinating care services of Prime Healthcare Providers staff. If you are insured, please check your insurance carrier to see if they cover hospitalization costs. If you are uninsured, you may want to discuss payment options with the financial services coordinator at the hospital. Some hospitals can arrange a payment plan for you.
- Are any imaging services provided in my annual membership fee?
Yes. As part of your comprehensive physical exam you will receive some bundled imaging services as determined by your age and medical need. For those additional imaging services not listed as a covered benefit, you will be responsible for paying for any of these outside services. We recommend that you check with your insurance carrier to determine what will be covered.
- Does Prime Healthcare Providers offer maternity care?
No. Prime Healthcare Providers does not offer maternity care services. We can refer you to an appropriate maternity care provider if you are pregnant or become pregnant while you are a patient of Prime Healthcare Providers. You may continue to get other primary and preventive care services at Prime Healthcare Providers while you are pregnant and your Prime Healthcare Providers health care provider will coordinate as necessary with your maternity care provider.
- Can I continue to see my gynecologist?
Yes. Prime Healthcare Providers does not offer gynecological care such as well female/pelvic exams. In addition, being a Prime Healthcare Providers patient does not prevent you from seeing any other provider of your choice whenever you wish. As with all outside services, you are responsible for such costs.
- Will I be notified if you add or discontinue services?
Yes. There may be changes in the services we provide. We will provide you with at least sixty (60) days notice of any changes to the services included in your annual fee. Our most current list of services is available on our website and also available at the Prime Healthcare Providers office.
- Do I have to pay the annual fee all at once?
Yes. The annual fee is to be paid annually. Should you be interested in splitting the payment with a second payment due in 30 days, you may use your American Express, MasterCard, Visa, or Discover Card. Flexible spending account debit or credit cards are not compatible.
- Is the annual fee tax deductible?
For patients who itemize medical expenses on their tax returns, the annual fee may be deductible. Speak with your accountant for further clarification.
- Can I get a refund if I am not satisfied?
If you have not received your physical examination, at the sole discretion of your physician, you may receive a prorated refund based on the services rendered to date. If you have received your physical, a refund is not available.
- How can I learn more?
To learn more about us, please contact Prime Healthcare Providers Medical Director, Dr. Phillip Weinstein for a personal tour and consultation.
Prime Healthcare Providers
902 Frostwood, Suite 262
Houston, TX 77024
(O) 713-932-0118
(F) 713-932-8303
Web site: primehcp.com
Web site: plantstrongdoc.com
Email: office@primehcp.com
