Highlights
As of January 16, 2023, Karen O’Day will be out of network for all insurances except Medicare.
Patients with Medicare as their primary insurance will have the opportunity to join the membership and we will continue to bill Medicare for all services that are covered by Medicare.
Karen O’Day is transforming the family practice aspect of the practice to concierge services on a membership basis. We are excited to invite you to join this revolution in healthcare that is exploding across the country.
If you are interested in becoming a member, please call and schedule a breakfast meeting with Karen. There is a $250.00 fee which will be deducted from the annual membership if the patient joins.
Frequently Asked Questions
Q. What is Concierge medicine?
A. Concierge medicine programs offer members convenience and a hassle-free patient experience. Through the concierge fees, concierge medicine programs are able to limit the number of members accepted into the program with attendant benefits that flow therefrom, such as prompt appointment scheduling, limited wait times, and 24/7 access to care delivered in a format convenient to members. Importantly, the concierge fee is not health insurance, and no part of the fee goes towards member payments for medical services, medications, or treatments. Members, individually or through insurance, remain responsible for paying for all medical services, medications, diagnostic testing, treatments, specialist care, hospitalizations, or other services.
Q. Is the membership fee covered by insurance?
A. In the vast majority of cases, insurance does not cover concierge membership fees. However, certain Health Savings Account (HSA) and Flexible Spending Account (FSA) plans may reimburse members for all or part of the concierge membership fee. Members should check with their human resources representative or HSA or FSA plan manager to find out.
Q. Do I still need insurance?
A. Yes. Concierge medicine program members should retain their traditional health insurance to help pay for any medically necessary services, medications, or treatments. Concierge fees do not cover medical services, medications, or treatments, including services covered by insurance plans. Members remain responsible for paying any deductible or co-payment, as dictated by their specific insurance plan, or, if members opt not to have health insurance, they remain responsible for the full cost of all medical services, medications, diagnostic testing, treatments, specialist care, hospitalizations, or other services.
Q. What medical services are offered by the Practice? Do Program Members have to pay for medical services?
A. Most everything you have come to expect from your Primary Care Provider, including acute medical care (for sick visits/minor injuries), chronic disease management (for example; diabetes, high blood pressure, thyroid disorders, etc), well woman’s care, telemedicine. I am available as often as medically necessary to provide the best care to you. The office visit is paid by the patient at the time of service, and they are given a 1500 form to submit for possible reimbursement by their insurance company. Medicare will continue to be billed directly by our office. Exemplary health care for QTR (quality time remaining). Ensuring that each patient has the highest quality health care available is the priority.
Q. What is telemedicine? Are there any fees for this?
A. Telemedicine means communicating with your health care provider about your medical concerns via a phone call, text, email, or even a video visit. Many patients are seeking out this type of care in place of an in-person office visit, or between office visits for convenience, or due to current health concerns revolving around COVID. Over the past 2 years, health insurance plans have routinely been covering video visits and phone call visits. Patient cost is $50.00 for telephone/video visits, and the patient is given a 1500 form to submit to their insurance company. As long as Medicare is reimbursing for telephone/video visits, medicare will be billed directly. If Medicare is not reimbursing, the patient will be billed directly. There is no cost to patients for telephone, text, or email questions.
Q. I usually only see a health care provider once or twice a year. Why can’t I just pay cash when a visit is needed?
A. If you are an individual who usually only sees a health care provider once a year, then you may not wish to have a yearly membership. In this case, to our non-medicare patients, we are offering a once a year visit which is a yearly physical exam, details are listed above, for one flat fee of $750.00.
Q. I only see Karen for Aesthetics or BioTe Hormone Replacement therapy, am I required to join the membership?
A. No, you are not required to join the membership for these services if you receive your primary health care from another Primary Care Provider. These services will not change, and will continue to be paid for at the time of services rendered.
Q. What if I am on the membership for Aesthetics, and Karen is also my Primary Care Provider?
A. If you are currently on our aesthetics membership, and you wish to join the membership for Family Practice, this will be offered with the cost offset based on the aesthetic membership you are currently on. This discount is only offered to the patients currently on the Aesthetics Membership, as of November 10, 2022, no new dual memberships will be afforded after that date.
Pricing
- Membership pricing on a monthly basis: $449.00 per month = $5,388.00 per year.
- Membership pricing on a quarterly basis: $1,212 every 4 months = $4,848.00 per year, which is a 10% savings.
- Membership pricing annually: $4,310.00 for 12 months a 20% savings.
- Family discounts offered based on the number of members in the family.
- For individuals who only see a health care provider once a year, there is an available option for a once a year physical that is 90 minutes, which includes; Full physical exam, EKG, ABIs. and basic blood panel (CBC, CMP, Lipid Panel, TSH, urinalysis), review of lab results, and refill of routine medications for 12 months, for $750.00.
To My Lovely Patients,
It is hard to believe that EverCare Family Practice has been open for nearly 6 years. For some of you, I have had the privilege of being your family provider for 8+ years, and you have followed me through several different offices. I have been blessed to build and nurture so many amazing provider-patient relationships during this time. We have shared many laughs, as well as tears through some of the most challenging times in your lives. You have entrusted me to be your healthcare provider, and I feel honored and blessed to have been given this opportunity. As you know, I take my work extremely seriously, and providing you and your family members with exceptional care has been and will always be my highest priority.
The current state of our healthcare system is making it increasingly difficult to provide high quality medical care. Providing personalized health care has become much more challenging in our current system that pushes quantity of care over quality of care. “Patient-centered” care has been pushed aside for payment-centered care. Insurance companies are continuing to decrease payments made to providers, and starting in 2023 they are decreasing their pay rates to providers once again. This decrease in insurance reimbursement rates would effectively force me to double my patient volume of appointments in order to meet my overhead and keep my office running.
Medical costs are significantly over inflated as third parties have forced their way into the patient exam room. I have spent hours on the phone with insurance companies in an attempt to get patient tests approved. Pharmacies and labs are no better in this regard. Daily, I advocate for my patients to help them find better prices for medications, labs, and radiology tests. Something has to change; medicine should not be a “one size fits all” approach. A term coined by Doc McGhee, “Quality Time Remaining, (QTR),” is how I attempt to model my life, and now my medical practice, regarding how much time we have left, and what is important in the time remaining. If what is happening doesn’t fit with the quality time remaining, then it is not worth doing. It is important to me to provide exemplary care to my patients, and with my current volume of patients, which is ever growing, I feel that in order to fulfill the QTR for my patients and myself, changes to the practice must be made.
EverCare Family Practice has offered self-pay options to patients since opening in March, 2017, and I am writing this letter to inform you that after January 16, 2023, I will no longer be billing any health insurance/medicaid plans, except for Medicare in regards to Family Practice. There will be no change for the aesthetic or Hormone replacement (via pellets) aspect of the practice. This has been a difficult decision, but I have made it so that I can improve the quality of care for my patients, and eliminate interference from third party payers. I can no longer tolerate the bureaucracy and red tape as it inhibits my ability to provide exemplary health care to patients. Beginning January 17, 2023, EverCare Family Practice will be offering a Membership providing a highly personalized approach for patient care, and will be limited to a small number of patients. Patients who participate in the membership will receive services that include direct contact with me 24/7 by phone, email, text message or video chat, with same or next day appointments, reduced wait times, extended visits, with house calls to patients who live within the Santa Fe, Tesuque, Pojoaque, Espanola, and Abiquiu areas when that service is needed.
We will also offer labs and other services at reasonable rates. Additional savings include less missed work due to delayed care, prolonged wait times, or having to see a provider for a simple problem that can be managed via telehealth or over the phone. I have enclosed some frequently asked questions with this letter, and I also invite you to call the office for more information.
In order to provide such personalized care, my practice size will be limited to 300 family practice patients, no change will be made to the aesthetic or hormone replacement (via pellets) only patients, as those aspects of the practice are quite small. I am sending this invitation to all of my existing patients first so that you have the opportunity to join me in this journey. I encourage you to contact the office as soon as possible to save your place on our growing list of patients. Concierge medicine via our membership, will allow me to continue to practice as the Nurse Practitioner that I trained to be, and provide the personalized, exemplary care that every patient deserves. I hope you will join me!
In summary; I am changing the Primary Care aspect of my practice. Aesthetic patients, and patients that are seen for Hormone replacement therapy (via pellets) only, will not be affected by this change, Medicare patients will have the opportunity to join the membership who see me as their primary care provider, and will still have medicare billed regarding all services that medicare pays for. Patients with insurance or medicaid plans, if you choose not to join our Membership by January 16, 2023, will need to find a new Primary Care Provider, and we will send your records to your new provider as soon as you find one. We will continue to refill a patient's routine, non-controlled substance, medication for an additional 3 months, if I have seen the patient within the past 6 months.
I understand that not all of you will be able to make this transition with me, but I do want to thank you for the honor of having served as your Family Nurse Practitioner.
Sincerely,
Karen C. O’Day CNM, CFNP
