Iris2016-5

General Questions

What is this practice all about?

We are the first practice in the state that is totally foregoing insurance reimbursement or fee-for-service payments in favor of a model in which you pay us an affordable monthly or annual fee to allow you to get personalized, unhurried, excellent health care.

Is this "concierge medicine?"

Well, not exactly.  Ten doctors would give you ten different opinions on the subject, but “concierge medicine” generally describes a very small patient panel and a very high price: upwards of several thousand dollars a year.  Our goal is not to fly to Europe with you to meet with your German orthopedic surgeon.  We want to provide in-depth, timely, individualized care for a moderate number of patients – small enough to know everyone well, but large enough to care for a sizable hunk of our community.  Most would call this “direct primary care.”

So what is "direct primary care?"

The idea is that you, the patient, pay us, your primary care physicians, directly, rather then relying on the very complicated reimbursement system organized by a third party payer – your insurance company.  Your insurance company is incentivized to limit payments. That leads physicians to see as many patients as possible in as little time as possible.  When you pay us directly, we are drawn to do one thing: provide truly excellent care.

My employer pays for me to have Hawaii-mandated comprehensive insurance, which covers office visits. Why should I have to pay you a fee, too?

We get that most people don’t like paying “extra” for something.  However, we know that we can not possibly provide the quality of care we think everyone deserves at the reimbursement rates mandated by insurance companies.  We think that $125/mo — which is not much more than most people pay for their cell phone’s data plan, or cable bill, or a daily visit to the cafe, or eating a few lunches out per week, or a glass of wine per night (you get the picture) — is a reasonable price for having a level of health care that greatly exceeds what a typical medical office can afford to provide.

I'm healthy and rarely see a doctor. Why should I pay a retainer for something I rarely need?

First of all, we strongly believe that the foundations of good health must be nurtured from early on — or poor health in later years is the certain result.  Fortunately, by addressing possible cracks in the foundation now, whether they be genetic, environmental, or lifestyle in nature, you’ll probably feel a lot better, too!  Also, when you do need a doctor, for a new problem or sudden illness, you’ll have someone that already knows you well, and is quickly available.  We think it’s worth it!

I see there is a major emphasis on health and wellness. Does this mean you can't help me if I have serious medical problems?

Not at all! Dr. Suber and Dr. Hollander have both been in practice for over a decade, and have cared for a great many very ill patients.  In fact, we think we have a great deal to offer those with some of the most serious chronic medical conditions, like diabetes, heart disease, autoimmune illnesses, and cancer, among others.  We both aim to treat with the least invasive and toxic means possible, but effective, excellent treatment is always our goal.

Services

What happens if I need medical attention after hours?

One of us will be available by phone to answer your concerns. If we need to order a lab test, X-ray, or discuss your case with an ER doctor, we’ll do it.

I'm a busy person. Do I have to come in to the office to see you?

We think there is something to be said for person-to-person contact — and physical exams are possible that way, too!  However, since we are not reliant on insurance reimbursement (which requires face-to-face meetings), we can manage a lot via phone, video call, or email, if that’s your preference.  We want to make this easy for you!

Since you say that all visits to the physicians are covered by the membership fee, does that mean that I can come in every week if I want, just to talk about articles I read on Medscape Today?

Well, not exactly. All your visits with both physicians ARE free of additional charges or copays.  That said, routine visits will be agreed upon by both patient and doctor and are limited by availability, to ensure the space to see people with urgent needs.

Do you take care of children?

We love to care for children! We are both trained in care for all ages, and also are parents of two young daughters.  We do not offer immunizations in our office (other than flu shots), but can refer if needed.

What about prenatal care?

This is something of particular interest to Dr Suber and her study of epigenetics and the importance of a mother’s health during pregnancy to her child. Expecting mothers will need an OB or midwife, but we would love to provide adjunctive pre-conception and prenatal care.

Once I pay my membership fee, is EVERYTHING in your office free?

Most everything. As per our Benefits page, most services are covered completely by your membership. Supplements are not included in membership fees, but are discounted for members. Special services for which we pay directly, such as certain specialized labs and the software fees for our Genotype diet, incur an additional fee; we charge you these costs at our price.

Insurance Questions

Does this mean we don't need insurance anymore?

No.  We think everyone should have at least catastrophic insurance — for unanticipated medical disasters.  An oft-used analogy of the current reliance on “comprehensive” health insurance, though, is that it is like getting car insurance that covers your gasoline… and limits the gas stations you are allowed to use… and negotiates individual prices with each vendor.. and so on. Everyone needs to see their doctor periodically. We think seeing a doctor who can take enough time to really think through your problems is best left outside the insurance system.  Having a safety net for major accidents or illnesses, though, is sensible.

Is there any way I could actually save money with this system?

Yes!  If you buy your own health insurance, choosing a high-deductible plan and joining our practice could absolutely save you money over a traditional plan.

For instance, let’s say you are a reasonably healthy 50 year old who sees the doctor 3-4 times a year and takes two generic medications. A hypothetical “Gold” plan might cost $400/mo with no deductible ($6600 maximum out-of-pocket), a $30 co-pay, 30% of lab and Xray costs, and $7/mo for each medication.  A high-deductible “Bronze” with the same $6600 maximum would be closer to $230/mo with $10/mo for each medication (which could probably be purchased paying cash for under $5/mo).

In a “typical” health year, with 4 doctor visits, a chest X-ray for a prolonged cough, routine labs, and the usual medications, see the table below to see how this patient actually saved money. Of course, there are other ways we can save you money — by limiting unnecessary visits to specialists, avoiding ER visits with timely interventions, and so on — but this hypothetical patient saved almost $700 while getting premium quality care!

PLAN   FEES  COPAYS  MEDS  LABS  XRAY  TOTAL
“Gold”   $4800     120   168   30   30  $5148
“Bronze”+Iris   $4260     0   96   40   50  $4446

Can I still use my insurance for medications and labs and X-rays if I join your practice?

Of course. With one caveat: if your insurance is an HMO-type, since we are non-participating with insurance companies, they will not pay for tests, equipment, referrals, or medications that we order on your behalf.  We are not fans of HMO plans, since they create a administrative burden on medical offices and delay care to patients; so we recommend changing to PPO plans if at all possible.  However, if you have no other good option, it is wise to maintain/find a primary care physician (“PCP”) willing to order such things for you when needed, and think of us more as your “consultants.”

Can I use my Flexible Spending Account to pay for your fees?

Yes, probably — although this falls in a grey zone and is plan- and administrator-dependent.  As long as you are using our fees to cover actual services (i.e. comprehensive preventative exams and follow-up), most plans (and the IRS) are friendly to this concept.  Talk with us about how best to do this.

I already have comprehensive insurance and rarely see the doctor. Why should I pay $125 extra per month on top of all that money?

We hear you.  Medical insurance has become incredibly expensive.  For instance, a 60 year old who wants HMSA’s middle tier “Gold” insurance is looking at $700/month for an individual plan.  Ouch.  We see it this way: you value your health enough to spend $700/mo, which is largely allocated by the insurance plans towards  potential emergency expenses.  Is is worth increasing that expenditure to $825/mo to have experienced doctors who can spend all the time you need with you and make that insurance truly a “health” plan instead of just an emergency plan? If your honest answer is that one or two 20 minute visits with a doctor per year is enough to truly maximize your health — then a traditional “no fee” medical practice might be fine for you, especially if you think acute health problems can be thoroughly managed in a 15 minute visit.   If you have your doubts that 30 or 60 minutes per year of a busy physician’s attention is a fair service to your health — then come see us!