How do I know if Summit Medicine and Pediatrics is right for me or my family?
Direct Access Medicine® care is a new concept to most people, and we are sure that you’ll have many questions about it, even after seeing our website. It is very important to us that you have an opportunity to have all of your questions answered clearly and completely, and we believe that it is best to do so in person. Call us to schedule a free and unconditional visit with Dr. Mike and the team to discuss your healthcare needs; we want to get to know you and would like you to get to know us. Contact us today!
What if I need medical services when I’m away from home?
Because of the close relationship that you develop with your doctor, we gladly provide you with the same exceptional service no matter where you are. Remember, with Direct Access Medicine care, Dr. Mike is always just a phone call away. If needed, we will locate a pharmacy nearest to you and have your prescriptions sent over, or communicate directly with another doctor to help facilitate medical care that is needed urgently.
Are my medical records ever shared?
No. We are fully-compliant with HIPAA and HITECH Act regulations and we maintain the highest privacy standards in our office. Because we do not contract neither with private nor with public health insurance agencies, we are never required (except under subpoena or court order) to share any of your protected health information with any third party, unless, of course, specifically authorized to do so by you.
Will I still benefit from Direct Access Medicine care if I don’t visit the doctor often?
Yes! The team at Summit Medicine and Pediatrics takes a proactive and in-depth approach to wellness and healthcare. We are devoted to maintaining your good health, not just to healing you when you are sick. We continually work to provide you with the knowledge and tools to keep you happy and healthy. We offer a variety of service levels to accommodate your changing healthcare needs, and every one of your visits with us will be tailored to suit your individual needs.
What if I need to see a specialist or go to the hospital?
While the goal is to reduce or prevent hospitalizations and specialty referrals, we understand that sometimes serious medical situations occur. We will happily work with your specialists and coordinate your medical care, to ensure that you continue to receive the exceptional care and attention you deserve. Whenever, possible, we will always refer our patients to sub-specialists, hospitals, laboratories, radiology centers, and other facilities that are still contracted with your health insurance plan so that you can take full advantage of your benefits.
Do you accept patients with pre-existing conditions?
Of course! Everyone deserves superb medical care. At Summit Medicine and Pediatrics, we do not discriminate against any patient, regardless of pre-existing conditions or former medical issues.
Do I still need health insurance if I go to a Direct Access Medicine doctor?
Participation at Summit Medicine and Pediatrics does not replace your need for health insurance. We recommend maintaining some form of insurance, such as catastrophe coverage, in case you need medical care that we cannot provide at Summit. While we work to reduce and prevent any serious illness, emergencies may occur that are outside the scope of what is available in the office. In such cases, we will continue to provide you with the highest quality of service.
Are there any hidden costs or fees?
No! There are no hidden costs or surprise fees. We offer a wide variety of in-office testing and treatment, and ALL costs are clearly established, published and specified in our Patient Services Agreement. However, should you need medical care from doctors and agencies outside your doctor’s expertise and capacity, we will take every opportunity to negotiate discounts on your behalf and further coordinate your medical care. Please visit the Patient Services page for an in-depth breakdown of the costs associated with each Service Level offered at Summit.
Do I give up my health insurance benefits if I go to a Direct Access Medicine doctor?
No. The healthcare you receive at Summit Medicine and Pediatrics is rendered outside of the contractual restrictions, obligations, and limitations of your health insurance plan, and each patient pays the doctor directly for services. However, when Dr. Mike orders labs and tests, prescribes medications, or refers you to a subspecialist, he will always do his best to ensure that such services are provided by facilities, pharmacies, and doctors who are still contracted with your insurance company, and each facility, pharmacy, and doctor will then submit a claim for reimbursement to your insurance company. This is also true for all patients who have Medicare and Medicare Advantage health insurance plans. Remember…Direct Access Medicine care is healthcare, not health insurance, and they are never mutually exclusive.
Is Summit Medicine and Pediatrics a member of an ACO?
Absolutely not. An Accountable Care Organization (ACO) is a group of public or private healthcare entities that develop, adopt, and implement a healthcare payment and delivery model that ties doctors’ reimbursements both to quality metrics and to reductions in the total cost of healthcare delivery for an assigned population of patients. Doctors who own or participate in an ACO are incentivized financially both to provide excellent healthcare and to reduce the cost of the healthcare delivered to their patients. In a very real sense, doctors who own or participate in ACOs quite clearly and inherently place themselves at conflict with the interests of their patients. They make themselves arguably more accountable to the ACO and to health insurance companies by having to comply at the highest level with the methods, protocols, and procedures of cost containment established and required by the ACO than they are accountable to their patients whose true healthcare needs may lie outside of acceptable parameters established by the ACO. In other words, ACO doctors get paid more by insurance companies when they reduce the cost of your healthcare (i.e. restrict or withhold certain services) while trying to keep their patients healthy. At Summit Medicine and Pediatrics, we always place the healthcare interests of our patients first. Dr. Mike is primarily, fully, and completely accountable to his patients ONLY, regardless of whether or not cost-savings measures suggested by health insurance companies or ACOs are applicable or appropriate for implementation in his patients’ plan of care.
Will my health insurance company reimburse me for my payments I make to Summit Medicine and Pediatrics?
Sometimes. It is very important to note that, according to federal law, patients who have Medicare, Medicare Advantage, and Arizona Health Care Cost Containment System (AHCCCS) health insurance plans are ineligible to submit claims for reimbursement. However, most patients who have private commercial or individual health insurance plans do have out-of-network benefits and may submit their own claims for reimbursement for services rendered at Summit Medicine and Pediatrics. In order to assist our patients in doing so, we provide to each of our patients an accounting summary of services rendered and payments made on a quarterly basis. This summary contains all the information, including diagnosis and procedure codes, necessary for their health insurance companies to process their claim and forward any applicable reimbursement funds directly to our patients.
Can I change my Service Level?
Yes. Direct Access Medicine care is flexible. You may change your service level to accommodate your changing healthcare needs. Remember, service levels are not insurance plans; you are choosing a suite of services that best accommodates your healthcare needs, and since your healthcare changes, we provide the highest level of flexibility in delivery of healthcare at all times. You may elect to change service levels once per month, and your decision to do so must occur before the 15th of the month. While having moved to a new service level, your position in the previous service level, if full, will be reserved for you to return within three (3) months, after which your position in the previous service service level may be replaced by another patient waiting to move to that service level. There is never a charge, fee or penalty to change or discontinue service levels, and we are always adding services, products and procedures, from which you can choose, to optimize your health.
Are All Service Levels Available for New Patients?
Unfortunately, no. Currently, Service Level 1 is full at 225 patients. For those patients who are at Service Levels 2-4 who wish to move to Service Level 1, we do maintain a waiting list, and as patients move permanently out of Service Level 1, we are happy to move them, in order, to this service level. Simply inform our staff that you wish to move to Service Level 1, and we will place your name on the waiting list and let you know when a place opens for you.
Will you ever raise your prices?
Since 2013, Summit Medicine and Pediatrics has not raised its prices. We recognize the economic challenges many of our patients face in paying for medications, tests and other medical services, and we are dedicated to providing affordable, accessible and excellent medical care to as many patients as possible. Although we cannot promise that our prices will never increase, we assure you that should we find it necessary to do so, we will afford to each of our patients ample opportunity to know and ask questions about such an increase.
Is there a limit to the number of patients?
Unfortunately, yes. Although we would love the opportunity to provide healthcare to all who come to us, it is simply impossible to maintain the same level of access, time and excellence to every patient unless we limit the number of participants. Currently, Summit is able to care for 500-600 patients, and, for those who continue to express a high level of desire and commitment to take advantage of Direct Access Medicine, we maintain a waiting list. On the bright side, Summit is working in partnership with Medicus Network, a national company that is working to assist more and more physicians as they transition to Direct Access Medicine practices.
What about laboratory and radiology tests?
At Summit Medicine and Pediatrics, we do perform several standard labs and tests in the office (e.g. ECG, urine dip) and we do not charge any additional fees for such tests. However, when your medical care requires more comprehensive laboratory or radiological testing, we will order and coordinate your testing with outside agencies that are contracted with your health insurance company. The agencies then submit claims for payment of these services directly to your health insurance company.
Why is there a separate charge for secure text and email service?
At Summit Medicine and Pediatrics, the security of your Protected Health Information (PHI) is our highest priority. We are fully compliant with every aspect and requirement of the Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health (HITECH) Act. As such, we have established strategic partnership with third-party companies whose software meets the rigorous standards of these federal regulations to ensure both static and dynamic encryption of your PHI during transmission through dedicated and secure means. The software that our patients use to communicate with Dr. Mike is licensed on an annual basis and is optional; those patients who wish to take advantage of the technology for rapid and efficient communication may choose to do so, but the service is not required. Remember… Dr. Mike is always a (free and secure) phone call away no matter what.
Can I choose to participate in secure text and email service at any time?
Yes, of course. We understand that the value, privilege and advantage of being able to send text, images and documents by mobile telephone and email directly to Dr. Mike may not be apparent when you first become a patient at Summit Medicine and Pediatrics. Just let us know at any time that you’d like the service… and within 24 hours, we’ll purchase the software licenses on your behalf, assist you with installation and implementation of the software, and in just a few days you’ll be able to text and email to and from Dr. Mike with full confidence that your Protected Health Information is secure! When you authorize Summit Medicine and Pediatrics to purchase the software licenses on your behalf, your licenses will be renewed annually unless you cancel the service. There are no refunds for services canceled prior to the annual renewal date, and the software licenses are not transferrable.