December 2, 2015

Frequently Asked Questions



What is a concierge practice? Otherwise known as “Direct Primary Care” or “Retainer-Based” Healthcare, this type of service was started in 1996. The core concept is to provide highly personalized and accessible care to our patients. A typical primary care physician will care for over 3,000 patients. In concierge practices, the number of patients is just a few hundred. Because of this, patients will enjoy numerous benefits not seen using today’s “traditional” healthcare model.
How is a practice like this run? Each patient pays an annual retainer fee, based on their age, which enables the practice to limit the number of patients and provide more personalized services. This fee covers all medical problems that may arise while enrolled in the practice.
What insurance forms do you take? None. Hold on a second, though, how can this be? Because we do not participate in any insurance plans, including Highmark, UPMC, and Medicare, your annual fee is all that will be required. This means no co-pays or deductibles, no bills to turn into insurance companies, no hassles and no hidden charges. That said, this fee does not replace having normal health insurance, which will be required for hospital admissions, diagnostic lab work, ER visits, or visits to other doctors.
What if an emergency occurs or I need to be hospitalized? If you have a life-threatening emergency, call 911 immediately. Before going to any urgent care facility, patients are asked to contact the doctor at any time of the day or night. Dr. Lamb will make every effort to address urgent needs directly that occur after-hours. If you do go to any emergency room, the doctor will be available 24 hours a day for consultation with emergency room personnel and for coordination of your care.
How can I join? Please fill out the “Get in Touch” section on the website to indicate your interest in the practice. If you have additional questions, we will contact you to discuss. Together, we can determine if our services and approach meet your needs and expectations. If you decide to join the practice, we will reserve a place for you and recommend starting with a comprehensive physical exam to assess your baseline health status once the practice opens.
What will I have to pay? The amount of your retainer fee will depend on your age. For more information and pricing, please visit our membership page.
Will my private insurance pay for my retainer fee? Because insurance plans vary, we cannot advise you regarding reimbursements. However, some Flexible Spending Account (FSA) and Health Savings Account (HSA) plans may pay for all or part of the monthly fee. Because it covers medical care, the concierge fee may also be used toward your deductible. Please check with your insurance plan administrator or Human Resources representative for clarification.
Will your orders for lab work, x-rays, physical therapy and medications be covered within my health plan? You are encouraged to verify this with your individual insurance plan, but as long as the service is billed by a participating provider, you should receive “in-network” benefits as in a traditional practice. For example, the laboratory or radiology group that performs the service will bill your insurance company for the blood work or x-rays, not our office.
My insurance requires prior authorizations for certain tests such as MRI’s. Will I still be able to get these tests covered? Again, you are encouraged to verify this with your insurance plan, but prior authorizations will be able to be obtained. Even though Lamb Medical is considered “out-of-network”, we will be able to obtain prior approval from your insurance plan for these services. You are also entitled to a patient appeal process directly to your insurance company, which our office will assist you with if necessary.
What is an executive physical? A 60-90 minute comprehensive visit that reviews your medical history in detail, provides a thorough physical exam, includes in office testing (EKG, PFT’s, vision, hearing, and lab draw) and orders for out of office testing that correlates with age-related health screening. Time will be available to answer your  health questions and a wellness plan will be developed with your individualized goals in mind.
Do you do gynecologic care?
The executive physical exam for a female patient will include routine gynecologic care, including a pap smear, when indicated.  Women can obtain all of their routine health maintenance at Lamb Medical.
What hospitals do you admit to? Dr. Lamb will be on staff at St. Clair Hospital, located at 1000 Bower Hill Rd. Pittsburgh, PA, 15243 as well as Washington Hospital, 15 Wilson Avenue, Washington, PA 15301. If you are admitted to one of these hospitals, you will be admitted to the hospitalist service, doctors who are on site at the hospital at all times. Dr. Lamb will oversee your care with them on a daily basis and conduct rounds during your hospital stay. If you are admitted to any other hospital, Dr. Lamb will stay in close contact with the admitting doctor and oversee your care until you are discharged. If the hospital is within close proximity to our office, Dr. Lamb will be able to visit you during your stay.
Do you charge for hospital visits? No. Your annual fee covers all of our services for you, including hospital visits.
Can I schedule an appointment after normal office hours? Our goal is to be available when needed, and if a patient is not able to get into our office during normal hours, we will work with them to find a mutually available time, including evenings and weekends.
Do you make house calls? While we are an office-based practice, there may occasionally be a situation where a patient is unable to get to the office. In these instances, Dr. Lamb may be available to see you in your home outside of our normal office hours.
Your contract includes a Medicare opt-out agreement. What does that mean? Lamb Medical practices the “fee-for-care” model, which requires the physician to completely opt out of Medicare. This means that Dr. Lamb agrees not to submit any Medicare claims or receive any payments from Medicare for any services provided to you. Dr. Lamb needs to renew this every two years. If you have Medicare and join the practice, you are required to sign these forms every two years as well. Doing so will not change your Medicare benefits in any way however as it relates to services outside of our practice. You will continue to receive Medicare coverage as before.
What happens if I move out of the area after I enroll? If you must transfer your care, we 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.
Can I wait and join later? By design, the practice is a membership concierge practice with a limited enrollment. Once that enrollment limit is reached, a waiting list will be established. Every effort will be made to accommodate interested patients, but the enrollment limit must be honored in order to continue to provide the highest standard of personalized care and service to all participating patients.
Should I change my insurance plan if I join?
Everyone in a concierge practice must have at least catastrophic medical insurance. Concierge medicine is not a substitute for insurance. Most patients will carry traditional insurance to cover all of their other medical expenses, but some may consider having a higher deductible plan with a lower monthly fee thereby making the concierge fee add up to less overall cost for their medical care. Please discuss your options with your insurance plan carrier.
Can you summarize concierge care?
The overwhelming benefits of concierge medicine can be summed up in a single word: TIME: time for the doctor to listen to the patient; time to delve into complex medical problems; time to do meaningful preventative care. Concierge doctors also serve the important role of patient advocate, helping you navigate the complexities of our increasingly difficult medical system. When necessary, they can find the best specialists to meet your needs. After hours when you have a medical problem, there is a familiar voice at the end of the telephone. The concierge physician becomes the captain of your medical ship, providing continuity of care and personalized service. In short, the concierge physician functions more like an old-fashioned primary care doctor, one with the time and skills to help you when you need it most.