There are many reasons I chose to to follow a membership model. The immediate goals of a membership are to average out your healthcare costs over the year and to encourage you to come in whenever you need to without worrying about the cost of that particular appointment. Additionally, having members (rather than a typical free-for-service model) allows me to focus on YOU. If you have a question that doesn’t require an exam, I can handle it over the phone. If you need a longer appointment, I’m not trying to move you through so I can see enough people to make ends meet. If you need to be seen more often, I see you more often. I can practice medicine the way it should be practiced. And frankly, while I want to help people, I also have a family to support. This is not just a hobby, this is my job.
What does it cost to join?
A membership is $40/month per person for the first two members of a household and $15/month per person for each additional member of a household. Almost everyone has me pull these payments automatically on the first of each month (or you can choose a different date that works better for you). There is an $80, non-refundable administrative fee per household to initially join. If your account lapses (if you either cancel or do not pay for 60 days), you will need to wait 6 months to rejoin or pay a $150 reinstatement fee.
What if I don’t want to join?
If you prefer to pay per appointment, there are lots of doctors who will see you under the usual model. Most of them will provide you with a “self pay” discount if you are paying out of pocket. Many people have told me, “But they are too expensive” or “I don’t like the usual healthcare system” or “I like your longer appointments” or “I like having open access to you.” All of the benefits of my practice (prices, longer appointments, being able to page me at any time) are available because of the membership model. You can choose which you prefer. If you have an unusual circumstance that eliminates all your options, please let me know.
What if I have insurance?
That’s great! I want you to have insurance for everything I can’t do in my office. Most people find that even with insurance, they have higher quality and more affordable care with me. You can still use you insurance for care outside of my practice. Most insurance will still allow me to order labs, write prescriptions, and make referrals. If you aren’t sure whether your insurance works with seeing me, call and ask if an out of network doctor can write a referral, etc. Some of my patients do have Kaiser or other insurance that will not let me do anything within their network…in this situation I am simply parallel to your regular insurance.
Will I have to pay anything at my office visits?
There is no copay with CSFM if you are a member. The cost of an office visit, my time, and miscellaneous supplies such as bandaids and durable equipment such as speculums are included in the cost of your membership. You will need to pay for any services outside my office such as labs, radiology, specialist appointments, hospitalizations, and medications. For those who are uninsured or underinsured (have insurance that doesn’t cover your labs or has a high deductible), I can run your labs through my practice account. Currently, a standard set of labs cost $10-20 for most people (depending on exactly which labs we do). The pathology portion of a pap smear is $20-50 but even high deductible health insurance will usually cover it for free; please know your insurance company’s preferred lab if you wish me to send your pap through them.
Sample costs for an uninsured (paying out-of-pocket) patient in a usual practice vs. CSFM, Either with a Membership or After Paying a $60 Appointment Fee:
|Well visit (adult or pediatric)||$140 for doctor’s time plus costs of labs and pap if uninsuredFree with insurance for the preventative part, billed the usual way for any additional issues||Free with membership …and you are encouraged to discuss all your concerns at the same appointment with no additional charge. If you need labs and have no insurance, cash price is usually around $10-20. Paps are $20-50. If you have insurance, please know their preferred lab and you will get preventative testing for free under the Affordable Care Act.|
|Suspicious looking mole||$150 for shave biopsy,or $250 for excisionor $350 if it turns out to be malignantCost of pathology||$0 for biopsy or excision regardless of whether it is benign or malignant
Cost of pathology (negotiated/reduced)
|Appointment to discuss a condition or obtain refills (blood pressure, asthma, depression, birth control, et cetera)||$140 for doctor’s time||$0 for doctor’s time|
|Urinary tract infection on a Saturday morning||$90 for doctor’s time
$50 “after hours” fee
Cost of urine dip
Cost of urine culture
Cost of antibiotics
|$0 for doctor’s time
$0 extra charge for urgent issues after hours
Cost of culture (negotiated)
Cost of antibiotics (generic if possible)
|Cut needing stitches||$250 for procedure||$0 for procedure
|Vaccines||Varies||Uninsured and Medicaid: free or reduced price vaccines at the Health Department
Insured: covered vaccines please obtain through your insurance, other vaccines will be most affordable at the Health Department
|Illness visit||$90 for doctor’s time||$0 for doctor’s time and feel free to bring up other issues as well…your cost will not go up|
How does your billing compare to standard medical billing?
Medical billing has become an extremely complex system of rules that even physicians themselves don’t always understand. The cost of an office visit is calculated using an algorithm based on how many problems are addressed and how many organ systems are examined, as well as the complexity of the medical decision-making. Doctors usually won’t do both a “regular” appointment and a biopsy at the same time because the rules won’t allow both to be billed at full price. If you have a biopsy or other procedure done, you (or your insurance company) is charged a much larger amount than if you had spent the same amount of time talking with your doctor about other medical concerns (whether that’s diabetes or depression). If your biopsy turns out to be malignant, a physician’s biller can go back and charge more than if it turned out to be benign—same exact procedure performed, different bill depending on what the biopsy showed. So the answer to how much you are going to pay for an appointment is…who knows?
By comparison, when you join CSFM, there are no additional charges to see me, and the additional charges for supplies and testing are just that: the direct cost for supplies and testing that have often been negotiated to a lower price. We can schedule as long or short of an appointment as you need in order to address your concerns. You can also return whenever you need to. This allows you to know up front what you are going to have to pay to see me and encourages you to get care when you need it instead of waiting.
What does your fee cover and not cover?
The monthly fee provides any care you need from me, Dr. Robin Dickinson, as well as incidentals needed to provide that care (such as syringes or needles, gauze, and so forth, as well as durable equipment that is cleaned and reused, such as medical instruments). It does not cover anything outside my office such as lab work, hospital or emergency room visits, specialist appointments, or x-rays.
Is this insurance?
No. This is not insurance. Just as a community supported agriculture (CSA) membership is a way of supporting your farmer directly in order to receive high-quality produce from a small local farm, a community supported family medicine is a way of supporting your primary care provider directly (by-passing insurance) in order to receive high-quality medical care from a small primary care practice. Even if you cannot afford comprehensive medical insurance, you should have a high deductible insurance plan to prevent bankruptcy in the case of major illness or injury.
What is Family Medicine?
The specialty of family medicine is centered on lasting, caring relationships with patients and their families. As a family physician, I integrate the biological, clinical, and behavioral sciences to provide continuing and comprehensive health care. The scope of family medicine encompasses all ages, sexes, each organ system, and every disease entity. Family physicians are trained in a variety of procedures as well.
Can I be “risked out” of your practice? If so, will I get a full or partial refund?
Everyone, regardless of how complicated his or her medical situation is, benefits from primary care. Current research indicates that approximately 80% of medical care can be provided by a primary care provider, and that care may actually be the best quality when obtained in a primary care setting. That said, 80% is an average. Many individuals can get close to 100% of their care from a PCP, while others may get half of their care or more from specialists and hospitals. Anyone can join CSFM and receive all of his or her primary care through this office. For some people, this will be all their medical care and for others it will be a portion. Anyone can choose to leave the practice at any time (see cancellation policy).
What about referrals or surgery?
I can refer you to specialists or surgeons if needed, but their care is not included in your membership with CSFM. That said, I am able to care for a majority of medical problems such as diabetes, hypertension, asthma, and depression, as well as do minor surgical procedures such as biopsies, sebaceous cyst removals, and incision and drainage of abscesses. I can provide basic orthopedic care, including management of certain fractures, though I will refer you if needed. I am also able to provide basic gynecological care, including pap smears and contraceptive counseling. At this time, I am unable to offer colposcopy due to the cost of a colposcope. I will be very clear with you if something is outside of my scope of practice or if I do not have the appropriate equipment or supplies.
Do you prescribe controlled substances for chronic pain?
Because I am serving an uninsured and underinsured population but I do not have federal funding or grants, I do not have the capability of providing adjunctive medications or long-acting pain medications at a reduced price. In the case of legitimate chronic pain, I am willing to discuss and support various treatment options; however, all management of chronic pain will be evaluated on a case-by-case basis, and any prescriptions for narcotics will be subject to a contract and appropriate monitoring. Occasional pain medication or muscle relaxants for appropriate indications and acute pain medication for an injury will be considered on a case-by-case basis. Additionally, in the state of Colorado, all prescriptions for controlled substances are listed on the Prescription Drug Monitoring Program (PDMP). I do not write prescriptions for medical marijuana.
Do you provide alternative treatments?
While I am open to alternative treatments and use them for myself and my family, I am not trained in providing them. I am part of your circle of providers, and just as I wouldn’t expect my massage therapist to prescribe medication for my headaches, I am only able to provide treatments and recommendations consistent with my training. Sometimes, I will recommend a complementary or alternative treatment provider for your concerns. I have been known to refer clients for anything from hypnosis to acupuncture, as well as options such as physical therapy or counseling.
Can I refuse further testing?
I do not order testing unless it is recommended for monitoring a particular condition or medication or will otherwise direct your care. I have refused testing for my own family and understand if you do so for yours. At the same time, it is always my goal to first do no harm. Certain medications require further testing to monitor safety. Certain medical conditions benefit from periodic testing. You have the right to refuse any testing you do not want; however, I have the responsibility to not prescribe any medications that are not safe without appropriate monitoring. I have done everything I can to make any further testing as affordable as possible.