What is membership medicine?
Membership Medicine is a new model, so it’s totally normal to have a lot of questions! The first big difference between a membership medicine and a traditional practice has to do with the relationship with insurance companies. In my membership practice, the financial relationship will be between The SHOW Center (me) and you (the patient). This allows me to devote 100% of my time helping you reach your health goals instead of being bogged down in paperwork and insurance reimbursement and bureaucracy. New patients will pay a one-time registration fee to be a member of the practice as well as a monthly fee or a one-time payment. This fee includes ALL visits provided by me and I will NEVER bill your insurance.
By removing the insurance barrier, this model allows me MORE time with you! Because of changes in how insurance companies and the government pay for medical care, providers in traditional practices need to spend more time away from patients and they spending hours each day in front of their computers charting. Two recent studies found that on average, primary care doctors spend less than half of their time with patients. This explains why over half of the providers in the U.S. spend less than 15 minutes (on average) with their patients during a visit. In my practice, visits will range from 30 to 60 minutes, depending on the complexity of the issue and your unique and individual needs. This allows us to get at the root cause of your concerns instead of just addressing symptoms with quick fixes. It also gives us time to discuss preventive measures that will keep you healthy for the long term.
Does this mean that you can cancel your medical insurance?
No. This contract is only for medical services provided by Dr. Quaile in her office. The patient should keep major medical insurance that covers the costs of Emergency care, Hospital care, radiology care, laboratory and pathology care, anesthetic care, or any other services provided by another physician or health-care provider. This contract is not medical insurance. No insurance or bills will be filed. However you may use your Health Savings Account or Flexible Spending Account.
Should you continue to have health insurance?
Yes. This contract with Dr. Quaile is NOT medical insurance. She is limiting the number of patients in her practice to 300 in order to take optimal care of the patients that contract with her. If someone cannot afford medical insurance, this is a low-cost alternative to contract with a high-quality healthcare provider for out-patient care. A patient should have some type of hospitalization coverage for catastrophic care.
Can the fees that I pay monthly for Dr. Quaile’s services be applied toward the “Deductible” for your medical insurance?
There is no way to know. Each insurance company has their own rules. The patient is encouraged to discuss this matter with a representative from their own insurance plan. It is very unlikely that Dr. Quaile’s fees will be able to be applied to your deductible. However you may use your Health Savings Account or Flexible Spending Account.
If I am a member of Dr. Quaile’s Practice, will I have to pay co-pays to come to see her?
No. The cost of every visit (up to 6 visits/year) is included in your membership. You may encounter additional charges for things such as prescription medications and laboratory tests. You will be informed of any additional charges before the service is provided. You retain the right to decline any services that would result in additional charges. You also have the option of reduced lab fees if you do not have insurance.
Do I pay the membership fee all at once?
Patients commit to an initial 6-month membership contract, and after that, you may choose to pay monthly, semi-annually or annually.
What if I have to have an X-Ray or some type of radiologic imaging?
X-Rays, CT Scans, Bone Density testing, Mammograms, MRIs and Ultrasounds are not performed in the office. When these tests are required, she will help you get the lowest price for any test you will need.
What happens if I need to go to the hospital?
This contract only applies to outpatient care provided in The SHOW Center. All hospital, emergency room, fees from the hospital, medications, and all hospital costs and fees from other providers except Dr. Quaile are not included in this contract.
What if I want to stop my membership?
You can discontinue at any time, after the minimum 3-month membership requirement, provided that you inform Dr. Quaile in writing. At the receipt of your termination letter, you monthly fees will be stopped and pro-rated. You cannot re-enroll into the practice without paying another registration fee. Dr. Quaile will provide all emergency care for 30 days after you terminate your contract in order to give you time to become a patient of another provider.
I am not sure I can afford an membership
We understand and during times of uncertainty this makes more sense than ever. We encourage you to consider the amount of money you’ll spend out-of-pocket in an average year for your healthcare needs. Are you having a problem getting the kind of access, timeliness and care you want from your healthcare provider. Do you have chronic illness, a family history of illness or concerns about your health that you have not had time to discuss with your primary care provider? Do you feel like you’re getting expert advice about preventative measures you should take to reduce your risk of illness? Does your doctor address issues such as sexual health, menopause, bone health, and cancer risk with you? Sometimes, the money you spend to prevent illness results in money saved should you become sick down the road and require extensive or long-term treatment. In fact, academic studies have shown that patients who belonged to a membership medicine practice had fewer emergency department visits and fewer in-patient admissions than those who did not. Unfortunately, good insurance coverage does not always translate to excellent care.
Can I submit charges to Medicaid, Medicare, Tricare, or Workman’s compensation?
No. Dr. Quaile is not participating in any government sponsored health-care service. She has opted-out of participation in Medicare, Medicaid, Tricare, and Workman’s compensation plans. The patient CANNOT submit any charges directly to these health-care providers for services provided by this practice. Dr. Quaile is opting out of all insurance coverage.
What services are included in the Membership?
This is an exclusive membership in the SHOW Center
- Up to 6 requested appointments/year with the provider. Visits not requiring medical care by the provider are not counted against the 6 visits. (i.e. BP checks, lab draws, urinalysis, e-mail exchanges, telephone calls, etc.)
- A full yearly physical exam (1 recommended per year)
- All vulvar colposcopy and all evaluations for vaginal/vulvar sexual health conditions
- Basic Annual Labs with annual physical (CBC, CMP, Hgb A1c, Lipid Profile, and TSH)
- Menopausal Management (does not include labs, medication, or pellets)
- Hormone Replacement Therapy (does not include labs, medication, or pellets)
- Vaginal Infections
- Urinary Tract Infections
- Thyroid management
- Basic Primary Care- upper respiratory infection, sinus infection, cholesterol management
- Integrative/Functional Medicine: Gut Health, Adrenal Health
- Sexual Health
- Genetic Counseling
- Telehealth Visits
- Intimacy/sex counseling for men, women, or couples
- Extended and relaxed visits from 30-60 minutes
- Direct access to Dr. Quaile via phone, email, and text
- If you have insurance you CAN use your insurance for any tests that are ordered outside of the annual exam (i.e. pap smear, mammogram, hormone levels, Myriad genetic testing)
Your membership also includes exclusive members only pricing:
- 5% off intimate products
- 10% off facial products
- Discounted pellet therapy
- Discounted injections- Vitamin D and Vitamin B
- Discounts on exclusive SHOW Center health education programs
- 10% off supplements with Fullscript
- Discounted lab fees for initial hormone evaluation and follow-up
What happens if I do not pay my monthly fees or if I cancel my Credit Card Payments without explanation or a termination letter?
Dr. Quaile understands that Credit Cards have to be changed if stolen or lost. We will contact you if your payments have lapsed. You will have 60 days to re-instate your membership with full payment up front. If you do not attend to this, you will be discharged from the practice and cannot be re-instated without discussing the issue personally with Dr. Quaile to rectify this problem.
What if I need to see Dr. Quaile more than 6 times in one year?
Additional visits with Dr. Quaile over the 6 PROVIDER visits during the year will be $50 a visit. The six visits do not include coming by to get labs drawn, blood pressure checks, or urinalysis.
What if I am not ready to join a membership plan and want to see Dr. Quaile for an initial visit or pay as I go?
For women who wish to continue their relationship with their current primary care provider but want to see me for menopause/perimenopause, sexual health, breast health, annual gynecologic exams or other specific Women’s Health/gynecologic concerns, I will continue to offer consults. Patients do not need to become a member of the practice to schedule consults. Please realize that doing the membership model gives you a huge advantage of having access and seeing Dr. Quaile more frequently at a reduced fee as opposed to pay per visit. Please call our office to inquire on specific pricing. You CAN use your insurance for any tests that are ordered (i.e. pap smear, mammogram, hormone levels, Myriad genetic testing).