First, we are for better or worse in a national health system where both public and private plans ask patients to contribute personally already in the form of co-payments and deductibles. Medicare is 80/20, and even Medicare eligibles with MediGap coverage have co-payments and deductibles. So, generally speaking, we know that patients will have more out-of-pocket costs as their need for medical intervention increases.

Plan-based healthcare by necessity focuses on medical necessity to then trigger medical services. That means healthcare is mostly doled out based on the level of medical need. What happens before medical need? Not much. There are some preventative services offered, which is great, but, those alone can’t create the kind of connected care Dr. Nanos practices.

A subscription model like Dr. Nanos’s practice, on the other hand, limits the patient panel to a much small number of subscribing patients. Free of plan medical necessity restrictions and restraints, Dr. Nanos and her practice staff can more freely and fully connect with patients to either try to avoid the avoidable medical problems, or, to more effectively manage medical problems. Ideally, high-connection subscription practices can over time actually save patients money by more effectively managing care before illness, avoiding what can be avoided, and then better managing illness when it arrives.

Second, what patient private fees purchase are additional services not covered by plans. The essential private fee services is the Annual Comprehensive Exam, which is a wholebody/epigenetic/total health exam delivered every year regardless of medical condition or necessity. While Medicare does cover a Welcome To Medicare Physical, and provide an Annual Wellness Visit, and private plans often cover more limited preventative annual physicals, Dr. Nanos’s Annual Comprehensive Exam constitutes a much more comprehensive examination. And, that examination is focused not just on looking for illness, but also on establishing overall health goals and connecting those goals to specific areas of focus: nutrition, exercise, mental health, epigenetics. Plus, unlike more limited private plan physicals, or Medicare services, the Dr. Nanos annual exam includes health coaching and Skype visits to maintain durable and persistent communication connection with patients all year to help patients reach their health goals, and to answer those health questions that are often hard to get answered by medical practices absent a scheduled office visit.

Dr. Nanos will provide plan covered care and bill plans to the extent she is in-network. She is Medicare participatory and in-network with PPO plans. She is not able to assist HMO patients or Medicaid patients due to state laws that restrict private fee healthcare services for those patients. Dr. Nanos will never bill a plan for her private fee Annual Comprehensive Exam. But, should a patient desire a plan-covered exam on some other date or time, and Dr. Nanos believes that could be helpful, she will on a different date/time provide a plan-covered exam. But she believes her Annual Comprehensive Exam and related communication support is sufficient to provide strong annual health guidance.

No, your private fees do not cover plan-covered services. Medically indicated and necessary diagnosis and treatment will be billed to the applicable plan to the extent Dr. Nanos is in-network.

With private direct practices like Dr. Nanos’s Kind Connected Care where patients subscribe with private fees for an annual exam and related communication connection, many if not most office visits are actually more about achieving health goals based on the exam and are less typically a medically indicated evaluation and management of illness. If you truly have a medically indicated need for evaluation and management of illness, that will be billed to plans. But if the fundamental basis of the office visit is to further advance your annual exam health goals, there will not be any plan or additional charges related to those visits.