Benefactors and Insurance

 

How to become a benefactor?

Each physician is only able to accept 300 Benefactors. Please contact our executive director at (209) 846-7916.

 

How does being A Benefactor work with insurance?

As a Direct Primary Care (DPC) practice, SLFMG does not accept insurance since all services that our doctors provide in our office, your home, or otherwise overseeing your care are included in your annual fee. All Benefactors, however, are required to carry a Preferred Provider Organization (PPO) insurance which provides coverage for prescriptions, lab testing, imaging and, if required, hospitalization.  Health Maintenance Organization (HMO) insurance in not compatible with DPC as the HMO requires their doctors to authorize and order all treatments, tests, and prescriptions you may require.

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. Many doctors 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 and 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: your insurance may pay 80% of a fee from a doctor on the “Preferred Provider” list, but only 50% of the fee if the doctor is not on the list. The patient is responsible to pay the rest.

I'm on Medicare, can I become a benefactor?

Certainly. Because St. Luke's Family Medical Group will not charge for any services, you may continue to use your current PPO Medicare benefits for your other health expenses. However, St. Luke's Family Medical Group cannot participate in Medicare or Tricare HMO programs like Secure Horizons, Kaiser Senior Advantage, or Tricare Prime Remote because decision must be made and authorized by your primary care manager. Please contact your insurance carrier with your questions about how to access PPO services

Will my insurance pay for the Benefactor fee?

The patient is personally responsible for the Benefactor fee which is separate from anything paid to or by your insurance company. 

Who do I contact if I have more questions?

Please contact our Executive Director, Karin Hennings at (209) 846-7916 or khennings@stlukesfp.org