Frequently Asked Questions.

What insurance does Dr. Mones accept and bill?

Please see policies for insurance details.


What is “Healthy Access”?


Healthy Access is "extraordinary" access to your own physician AND you choosing to be proactive in maintaining health.  I will feel Maitree Family Medicine is successful if my patients can say "I receive the care I need and want, when and how I need and want it, from a doctor who knows me."  

In addition to the office visit care, Healthy Access service provides 24 x 7 phone and email access to Dr. Mones, after-hours and weekend care at the Maitree Medical Office if needed, email scheduling of your appointments if needed, telephone or e-visits with Dr. Mones when you cannot come in to the office but need a consultation, and more convenient (but secure) access to your own health information.  

Healthy Access is a service that allows you more accessibility to your doctor and pays Dr. Mones to take time out of his day to communicate with you and to be accessible to you.  It is much like tech support, but for your healthcare rather than for your computer.  Like tech support, Healthy Access is NOT insurance, but instead, a service of accessibility, availability, and communication with an expert.  Although Healthy Access is an small additional expense to the patient, it is both necessary to support this model, and necessary to support good health.  Dr. Mones believes that Healthy Access pays off for patients by fostering better health and peace of mind, with a lot more convenience than the average clinic. 

Healthy Access services are beneficial and convenient, but are considered "non-covered" benefits by insurance companies.  Because insurance does not pay for this kind of support from a doctor, the typical doctor is usually not accessible unless you make an appointment and wait.  The model of care at Maitree Family Medicine is to have patients pay directly for this essential piece that insurance won't pay for in order to "break the cycle" of dependence on large volume "illness" focused care.  

 

What is the cost of Healthy Access ?
There are slight changes beginning in January 2013.  Healthy Access will be charged per patient (rather than per household) but the fee per patient has stayed the same since 2009 and is $120/year.  There is a discount of $20 for paying ahead for the year, a discount of 50% for each additional household member and the fee is waived completely for younger patients who are still on their parent's insurance to reduce the burden on larger families.  The fee is otherwise the same for all patients regardless of their mode of communication.  

Is Healthy Access covered by my insurance?
No.  Your insurance does not pay for Health Access because it is considered a “non-covered” benefit by health insurance companies.  It is a health related expense and will qualify for flexible spending plans, health savings account expenses, etc but unfortunately cannot be applied to the deductible on health insurance.  Healthy Access is direct 24 x 7 access to Dr. Mones by phone or email, access to personalized health care by the doctor who knows you, and the convenience of off-hour and weekend telephone/email visits when appropriate.  Dr. Mones believes all patients deserve to have this level of care but unfortunately insurance companies are not yet covering this.


Can I pay for Healthy Access out of a Health Savings Account?

Yes, but every plan has slightly different policies.  Most HSAs have no problem with people using their HSA dollars for health-related expenses and health producing benefits such as Healthy Access.  You should review the rules of your specific account with your employer.

Could my employer pay for my Healthy Access fee directly?

Yes.  We would be happy to explain to your employer that their employees and their businesses will benefit from the quality of care provided.  Healthy Access can help patients avoid missed work, or stream-line the visit to your doctor by using email and an e-visit (email, phone or video).  Imagine that your doctor’s waiting room can be your own home or work place until the e-visit appointment.  Please let us know if you would like us Dr. Mones to talk with your employer about why it is in their best interest for you to receive this type of care. Or you can print out this FAQ list for your employer.

Is this ‘Concierge Medicine’?

No!  “Concierge” medicine creates special access for patients who can afford it, whereas Maitree Family Medicine allows a person of any means to get special access at a very affordable rate.  “Concierge medicine”, “retainer practices” or “membership practices” require a hefty membership fee prior to being seen. This fee creates an obstacle to accessing the physician and contributes to a two tiered health system – those who can pay and those who can’t.   There is no membership fee at Maitree Family Medicine and the practice is not deemed a "retainer practice" by the State of Oregon.  In addition, the cost of care at Maitree Family Medicine per visit  is 20% to 40% less than the average family medicine clinic.  This means that patients with no health insurance and of any means, can have more access to care at Maitree Family Medicine than at most clinics.   The Healthy Access “non-covered benefit” is also a value added service, and although it is not insurance, Healthy Access may save patients money by preventing unnecessary visits through good communication and prevention.  

 How is the practice model different from the typical practice?

Dr. Mones uses the efficient and effective application of technology, a low-overhead design, and a small direct fee for Healthy Access - which is the old-fashioned family doctor approach delivered with modern technology - to break the cycle of dependence on high volume, assembly-line medicine.  The goal is to provide unhurried, personalized and convenient care.  Dr. Mones sees in his office 8-12 patients per day at the office (rather than the typical 20-30 that many physicians see per day), allowing him to stay on time with patients in the office, and have time to communicate via phone and provide email visits when appropriate.  This means fewer patients, yes, but more quality and greater satisfaction for patients and doctor.  Slowing down allows a physician to provide the best medicine, and use the latest medical evidence, and, just as importantly, continue to be fulfilled practicing medicine.  This model of care is inspired by the Ideal Medical Practice model.


To understand more details of how this model works when others may fail, and to understand how the Ideal Medical Practice model works, it's important to understand how and why the old fashioned doctor has nearly disappeared and been replaced with high volume medicine in primary care and urgent care with less and less direct contact between patient and physician.  This evolution was not inevitable, nor was it progress.  It was due to mulitiple short-sighted adaptations to changes in the healthcare environment rather than due to forward-thinking progress.  Unfortunately, most physicians and patients are now entrenched in a system of primary care that is mutually unsatisfying.  (see Primary Care Crisis below for more details)


 Dr. Mones utilizes three main approaches.  1) Using technology effectively and efficiently with the goal focused on enhancing the patient-physician relationship. 2) Maintaining low overhead:  the clinic is comfortable but not extravagant; it is small and simple enough that one employee and one doctor can easily run the entire clinic; and the technology employed is carefully chosen to reduces costs, not create them.  3) Charging patients a small, direct fee for the Healthy Access service they receive at Maitree Family Medicine.


Why aren't other doctors practicing this way?

 

Actually other doctors are following this model.  Thousands of doctors are experimenting with new and different models of care across the country with the hope of improving patient care and patient and physician satisfaction. I have created a model that fits my patients as well my personal and professional beliefs about what is important in medicine.  I have been influenced and inspired by the Ideal Medical Practices Model.


Primary Care Crisis:

Physicians have been leaving clinical medicine at a higher rate since the 1990s creating a crisis in primary care.   The increasing control exerted by insurance companies and the ever increasing complexity of medicine and increasing demands on the primary care physician are at the root of this crisis.  The system has been getting sicker, but insurance companies seem to be getting healthier and stronger during this period of time.   Although called “health insurance”, most insurance works much like accident insurance and is, more accurately “disease insurance”.  The ultimate goal for the insurance company is to limit expenses and to make profits, which inevitably is in tension, if not conflict, with the physician's goal of giving patients more time and attention (and making a living him or herself).   Most insurance plans don't pay the doctor unless a patient comes into the office for a visit - so in essence, does not pay the doctor, outside of office visits, to keep you well or to help you manage your health problems - although this may change with the affordable care act.  Nor do the insurance companies pay for additional physician workload or the additional office staff required to deal with the insurance bureaucracy.   Clinics need to keep the doctor's appointment slots booked solid to make sure they can generate enough income to pay these higher office expenses.  The doctor ends up with a large patient panel in order to generate enough visits everyday.  Doctors then have to delegate much of the talking, education and even relationship-building to other staff,  further increasing the expenses and need for more visits.  Meanwhile, there is little to no reimbursement (yet)  for keeping you well and preventing illness.  The resulting quick, time-pressured visits (not to mention the long waiting times) are de-humanizing both for the patient and physician.   Patients then try to avoid the doctors office until they are sick - so clinics have to keep taking on more patients to keep appointment slots full.   It is a cycle that leads to ever more impersonal, hurried, inconvenient, inefficient and unsatisfying visits for patients and doctor.  

In this way, the primary care system is incentivized to focus on “sick-care” rather than proactively focused on “health-care” and prevention.  Doctors have not consciously chosen to practice this way, but instead are entrenched in the present model and most doctors and patients find it difficult if not impossible to break this unhealthy cycle.   The crisis in primary care really comes down to the dissatisfaction that physicians and patients have in this high volume environment.  The Ideal Medical Practices movement and Maitree Family Medicine aims to alleviate the symptoms by enhancing the patient-physician relationship, staying proactive, and refocusing on health and wellness.