Frequently Asked Questions
How does Personal Medicine work?
A patient enrolled in a Personal Medicine practice pays an annual enrollment (or retainer) fee, either in one lump sum each year or monthly to spread the payments out over the year. The fee is paid whether the patient sees the doctor or not. Often physicians charge “extra” for co-pays and deductibles and other fees the insurance will not cover. Dr. Hansen-Smith does not require this additional payment, so the only payment to her from the patient is the enrollment fee.How many times I can be seen under this agreement?
You may be seen as often as you like or need. There are no limitations to the number of visits over a month or year.How long I can spend with the doctor at each visit?
In order to deal with all of your concerns, we attempt to give you as much time as you need. You can let us know when scheduling the length of time you would like to spend with the doctor.What are the limitations of Personal Medicine?
The annual enrollment fee does not replace the patient's health insurance. It does not cover lab or X-ray charges, or visits to other doctors or hospitals. Certain insurances (HMOs, Medicare and Medi-Cal) will not work with retainer-based practices, so they will not be accepted at Hansen-Smith Family Medicine.How many patients will be accepted in this practice?
Hansen-Smith Family Medicine has an absolute limit of 600 patients. This is set in order to maintain the best availability and care possible to those enrolled in the practice, and will not be increased. Once the limit has been reached, people wishing to become patients will be placed on a waiting list.What is the difference between HMO and PPO insurances?
HMO stands for Health Management Organization. This type of insurance started in the 1980s to try to bring down the cost of medical care (sound familiar?). By limiting the kinds of treatments, tests and doctors a patient can see to those that are the least expensive, these companies have been able to offer a lower cost premium to the patient. They pay a doctor a certain amount of money each month or year to take care of each patient, whether the patient is seen often or only once a year. Many doctors have decided to stop taking patients with this type of insurance because they don’t get paid enough to support their medical business.
PPO stands for Preferred Provider Organization. This is a “fee for service” type of insurance where the doctor is paid after the patient is seen, when they send a bill to the insurance company to pay for the medical service that was given. Patients may see any doctor they want to, but if the doctor is not on the Preferred Provider list, the patient will pay more “out of pocket” to see that doctor than if they saw one on the list. (For example, the insurance may pay 80% of a fee for a doctor on the list but only 50% of the fee if the doctor is not a “Preferred Provider” and the patient pays the rest.)
Hansen-Smith Family Medicine will accept all PPO insurances and patients without insurance.Why won't HMOs work with retainer-based practices?
HMOs consider the small advanced (or capitated) payment to the doctor enough to "retain" the services of that doctor for each of their enrolled patients. They count on many of their patients not having to see the doctor very often, and only a few having to see the doctor frequently. The insurance company will not let the doctor collect more than the visit co-pay from the patient. This usually amounts to less than $200 a year for each patient, which is less than what an annual physical examination service costs the doctor to provide.Do Personal Medicine practices accept Medicare and Medi-Cal?
The government has not decided on their regulations for Personal Medicine practices. To avoid penalties in the future if the regulations change, many doctors do not take patients with these insurances.Will my insurance pay for the enrollment fee?
The enrollment fee is separate from any fees paid to or by your insurance company. This is a separate fee for which the patient is personally responsible.Will the enrollment fee cover labs, X-rays and specialist visits?
The enrollment fee covers only services provided directly by Hansen-Smith Family Medicine. Labs, X-rays and specialists have their own charges and will bill the patient's insurance a separate fee. Anything not covered by the patient's insurance is the patient's personal responsibility.Will I be paying co-pays at my visits?
While some physicians in retainer-based practices still require patients to pay co-pays and any fees not covered by their insurance company for medically necessary services, Dr. Hansen-Smith does not. The annual enrollment fee is the only payment that the patient makes to the doctor.Can the fee for Personal Medicine count toward my deductible?
The insurance company has to have a bill from a doctor’s evaluation and treatment before they will allow money from the enrollment fee to cover part of the deductible. Doctors practicing Personal Medicine send the insurance company a bill with this information, then this part of the enrollment fee can be counted toward the patient’s deductible. Many doctors in Personal Medicine practices still collect the co-pay and charge the patient the amount not covered by their insurance company. Dr. Hansen-Smith considers that cost already paid by the patient, so the patient owes no more money to the doctor than the annual enrollment (or retainer) fee.What if I don't have insurance?
The annual enrollment fee covers all services by Hansen-Smith Family Medicine, regardless of whether a patient has insurance or not. There is no penalty for those without insurance.
There is a wide range of fees charged by different doctors in a retainer-based practice. It can be as low as $1,000 for an adult, or as high as $20,000 a year for an adult in some areas of the country. Most doctors charge between $1,000 and $2,000 per adult per year. Children are often charged a lesser amount, and some doctors give discounts for larger households.
No, the enrollment is meant to be renewed annually. The fee may be paid once a year or on a regular basis over the course of the year.Can the agreement be cancelled?
Yes. The agreement usually renews automatically each year, but the patient or the doctor may cancel the agreement instead of continuing in the practice. If this happens during the middle of the enrollment year, and the patient has paid to the end of the year, Hansen-Smith Family Medicine will refund the part of the fee that has not been used. Once a patient has cancelled the agreement, the doctor will assume that the patient will not come back to the practice. (For example, a patient will not pay for one month when they need to be seen, cancel, and then return with payment two months later to be seen again.)Will I have to use an Urgent Care or Emergency Room after hours?
While Dr. Hansen-Smith will be available to you at all times, there may be medical situations that require more advanced care than she can provide. Only in these cases would you be advised by the doctor to present to an Urgent Care or Emergency Room. In the event of a medical emergency, patients are advised to call 911 prior to calling Dr. Hansen-Smith to begin evaluation and treatment as soon as possible.What happens if I have to be admitted to the hospital?
If Dr. Hansen-Smith determines that you need to be admitted from her office, she will coordinate transportation and call ahead to the hospital to let them know you are coming. If necessary and possible, she may also accompany you to the hospital to assure that the admission to the hospitalist goes smoothly. If your are admitted through the Emergency Room, they will contact the hospitalist for admission. You or a family member are advised to contact Dr. Hansen-Smith to let her know about the admission. She will be available to visit with you in the hospital, coordinate care with the admitting hospitalist and treating specialists. In this way, she can help more clearly explain your situation, test results and give you a better idea of what to expect during admission and after discharge from the hospital. Dr. Hansen-Smith does not directly admit patients to the hospital.Do you make House Calls?
While Hansen-Smith Family Medicine is an office-based practice, there may occasionally be a situation where a patient is unable to get to the office. In these instances, Dr. Hansen-Smith may be available to see you in your home outside of our normal office hours.What are your office hours?
Our office will be open Monday through Friday from 9 AM to 5 PM. Appointments are encouraged in order to give each patient adequate time to deal with all of their concerns. If you present to the office with an urgent need, we will work to see you as soon as possible, but realize that there may be a bit of a wait while we see patients that have scheduled appointments.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.What if I need medication refills after normal office hours?
Not only do patients have direct access to Dr. Hansen-Smith, but to her Medical Assistant as well. If a patient has discovered they are unexpectedly out of medication outside of office hours, they can contact us for refills to avoid missing a dose.What if Dr. Hansen-Smith is on vacation?
In the event that Dr. Hansen-Smith is out of the office for a vacation, she and her medical assistant will usually still be available by phone. If not, there will be a fully qualified physician available locally if needed. Patients will be notified as to how to contact that physician if necessary.
© 2006 Dr. Karen HansenSmith 2440 Tulare St., Suite 240, Fresno, CA 93721