Is there a cash discount on other medical services I might need?
Yes, here is the current price list. If you add up your current co-pays and deductibles, you may well find that using these discounted prices and paying upfront for certain tests saves you money.
Do I still need health insurance?
Since complex care, surgery and/or hospitalizations are a reality for most people at some point, we advise having medical cost sharing or insurance for these occasions. However, our practice offers a level of primary prevention and treatment that can reduce those events.
As an alternative to traditional high-deductible insurance plans, Avicenna Direct Care has partnered with Sedera Health to offer a complete care package: Avicenna membership for routine care + Sedera’s ACCESS solution for complex care. As an Avicenna member, you receive DPC pricing for Sedera membership so that both your routine care (Avicenna) and complex care (Sedera) expenses are addressed. Sedera is not a “network plan,” so, with our help, you can choose the specialists and hospitals that are right for you.
For example, a family of five, with adults who are “thirty-something,” with a $500 IUA (Initial Unshareable Amount) only pays $551/month for Sedera cost sharing. This addresses catastrophic or larger medical needs – surgery, other hospitalizations, etc. It also covers childhood vaccinations and adult preventive tests such as colonoscopies etc. Full coverage guidelines are downloadable.
If you prefer traditional insurance and are an Avicenna member, you can generally choose a high-deductible plan such as many employers offer, or a “Bronze plan” if purchased through the federal healthcare exchange.
Though your Avicenna membership fee will not count toward your health insurance deductible or annual out-of-pocket limit, any tests, procedures or medications that we order or prescribe will count toward your annual deductible/ISA (and out of pocket limit if they are eligible for insurance reimbursement).
Sedera and most insurance plans require advance approval of certain tests and procedures, as well as any surgery or hospitalization. If you have traditional insurance, we will help you find an in-network specialist to deliver the care you need, and s/he can request such approvals if/as needed. If you choose Sedera, you have the freedom to use any specialist or hospital that we might recommend. Either way, we will coordinate your primary and specialty care.
What if I have an HMO plan that requires an in-network primary care physician?
Since we cannot serve as an in-network primary physician, we encourage HMO members to consider a less restrictive plan (obviously, Sedera is an example, but a PPO would be the next best option) at their next opportunity.
Meanwhile, if you prefer to pay cash for services and medications that we do not provide or list, we can help you find the most cost-effective solution.
How often will the fee go up?
Our commitment is to maintain our current fee structure as long as possible and to keep any future increases as low as possible. If we do have to raise fees, we will always notify you in advance of your monthly renewal date.
Can I use my HSA to pay monthly DPC fees?
The US tax code does not allow that at this time. However, the President’s Executive Order of June 24, 2019, includes a directive that regulations to permit this be drafted within six months. So when you have the opportunity to create an HSA, e.g. at open enrollment, it is well worth considering.
Apart from the monthly fee, however, any test or treatment that we order for you, such as labs, radiology, and medications, can be applied to an HSA, HRA, or FSA, or, if it is reimbursed via your health insurance, your deductible.
Can I deduct my fees from State and/or federal taxes?
Your membership fee is not defined as a “medical expense” in Pennsylvania and therefore is not tax deductible. Please verify current federal law with your tax preparer or accountant.
What if I have Medicare?
We will ask that you sign a waiver stating that neither we nor you will request reimbursement from Medicare for our services. However, you can use either traditional Medicare or a Medicare Advantage plan to cover costs of medications, labs and imaging that we or other doctors order, as well as hospital services or surgery.
What if I have Medicaid?
Medicaid regulations do not permit us to order tests or other services for you, so we cannot register Medicaid patients at this time.