Frequently Asked Questions


1.

What is a retainer model?

2.

What is the mission?

3.

What services are provided?

4.

Do you offer Disease Management?

5.

Do I need insurance if I enroll with you?

6.

Is there a co-pay?

7.

Do you bill Medicare for the monthly retainer fee?

8.

Will my insurance reimburse my monthly fee?

9.

What about lab, x-ray and specialists’ fees and hospitalizations?

10.

What if I have an emergency or need hospitalization?

11.

What if I need to see a specialist or need surgery?

12.

Can I still see my gynecologist?

13.

What about the cost of prescription medicines?

14.

Will I be required to pay even if I do not need to use your services?

15.

What if I get married or have/adopt a child? Can I extend coverage to my new family members?

16.

What happens if I move out of the area after I enroll?

17.

Can I enroll in the 121MD plan in the future?

1. What is a retainer model?
The 121MD retainer model allows physicians to minimize their practices. By design, 121MD physicians treat hundreds, as opposed to thousands, of patients, enabling them to deliver timely, highly personal and comprehensive services. 121MD charges a reasonable monthly fee per patient for prompt access to their personal physician. Facilitated payment of the retainer fee entitles patients to office-based services and telephone conferences if needed.

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2. What is the mission?
Our mission is to provide unimpeded access to preventive services and early treatment of acute illnesses in order to maintain patients’ health and improve their quality of life.

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3. What services are provided?
Refer to SERVICES. Also, refer to the Medical Services Agreement (MSA), which is available in our office.

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4. Do you offer Disease Management?
Yes. It makes sense that your physician (who examines and sees you regularly) should be the point person in managing your care. Careful monitoring and management of patients’ health on a one-to-one basis improves their well-being. Personal management of chronic diseases such as asthma, congestive heart failure, depression, diabetes, high cholesterol, hypertension and others, combined with patient education, results in improved outcomes. The 121MD model takes financial incentives out of the disease management equation and focuses care where it should be – on the patient.

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5. Do I need insurance if I enroll with you?
Yes. Patients must be insured by a PPO, Medicare or a major medical plan. This allows for coverage of services provided outside of our offices. We do not bill any insurance companies or Medicare, nor do we accept patients enrolled in managed care plans such as health maintenance organizations.

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6. Is there a co-pay?
No. Your fee secures your access to a 121MD physician’s care during regular office hours without incurring a co-pay. However, certain supplies (crutches, splints, etc), as noted in the MSA, will be charged to you.

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7. Do you bill Medicare for the monthly retainer fee?
No. We do not bill Medicare.

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8. Will my insurance reimburse my monthly fee?
Because insurance plans vary, 121MD cannot advise you regarding reimbursements. Check with your insurance plan administrator or Human Resources representative at work for clarification and exploration of our vision to provide primary services for a monthly fee using pre-tax dollars.

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9. What about lab, x-ray and specialists’ fees and hospitalizations?
There is no charge for in-office lab work (strep screens, urinalysis, urine pregnancy tests, etc.). Out-of-office charges, services provided by specialists and hospitalization expenses should be billed directly to your insurance company or Medicare. For specifics, please discuss with your insurance
company or Medicare representative. Also, refer to SERVICES and to the MSA.

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10. What if I have an emergency or need hospitalization?
If you have a life-threatening emergency, call 911. A 121MD physician is available 24 hours a day for consultation with emergency room personnel and for coordination of your care. Specialty referrals will be discussed with the emergency room physician if warranted. If you are hospitalized for an acute illness, a hospitalist physician will oversee your treatment until you are discharged to your regular 121MD physician for follow-up care.

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11. What if I need to see a specialist or need surgery?
You and your 121MD physician will make joint decisions about referrals to specialists for evaluation and treatment of conditions felt to be beyond his/her scope of practice.

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12. Can I still see my gynecologist?
Yes. Many women prefer seeing their gynecologist for well-women care. 121MD affiliated physicians are well trained and experienced in routine, outpatient gynecological care. Of course, we will support and facilitate your choice. If you seek treatment outside of 121MD, you will be responsible for those charges.

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13. What about the cost of prescription medicines?
Oftentimes, we can start a patient’s treatment with samples. If you take several monthly prescriptions, you should consider separate insurance for pharmacy coverage or a prescription discount program.

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14. Will I be required to pay even if I do not need to use your services?
Yes. Paying your fee allows access to your physician whether you are sick or well. Preventive care is a primary focus of our practice: 121MD strongly encourages wellness consultations, regular office visits and yearly physicals. Please see the MSA for details.

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15. What if I get married or have/adopt a child? Can I extend coverage to my new family members?
Every effort will be made to accommodate you and your family. Children (age 6 and over), spouses and partners can be added as long as there is space available in the physicians' practice.

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16. What happens if I move out of the area after I enroll?
If you must transfer your care, your 121MD physician will assist you in finding a new doctor. Your medical records will be promptly sent upon receipt of your Medical Release Form. The balance of your fee will be prorated and refunded if you are not able to transfer to another 121MD physician. See the MSA for details.

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17. Can I enroll in the 121MD plan in the future?
By design, 121MD physicians will limit enrollment to accommodate a small, personalized practice. When a practice fills, every effort will be made to accommodate inquiring patients by:
a. introducing them to an affiliated 121MD physician in the area or
b. placing them on a waiting list in the event space becomes available.

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DISCLAIMER
The content on this website is for informational purposes. The precise nature and scope of services to be provided are set forth in the Medical Services Agreement (MSA), which is available in 121MD offices. In the event of any conflict between the preceding and the MSA, the MSA will prevail. One To One MD, P.A. is not an insurance company or product.


 

     
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