How Do I Become a Benefactor?
We do not bill or collect from any insurance company or government program. We are able to provide the outstanding time and customer service because we work for and are paid directly by our benefactors, taking the “middleman” out of health care. This type of practice is called Direct Primary Care (DPC). For more information, see: What Is Direct Primary Care?
Most offices spend fifty percent or more of their time, energy, and effort trying to collect money from their patients, insurance companies, and big government program like Medicare. That means that most doctors actually are paid and work for your insurance company or the government. But not at St. Luke’s Family Practice, we’re different – we work for you!
No. Because we do not participate with any insurance programs, there are no co-pays when using our practice.
Being a Benefactor at St. Luke’s Family Practice covers any expense for your primary care doctor: over the phone, in our office, at local hospitals, in your home, or at a nursing or rehabilitation facility. Additionally, your Benefactor fee covers any test or procedure performed in our office. However, the physician component of primary care is relatively cheap. You will still need your health insurance to cover specialty consultations, diagnostic testing, operations, or hospitalization.
Preferred Provider Organizations (PPO) insurance, Medicare, and TriCare work well with St. Luke’s Family Practice. In fact, any health insurance works well with St. Luke’s Family Practice except for Health Maintenance Organizations (HMO’s). HMO’s try to reduce costs by using a limited panel of “highly managed” health care providers in order to provide care at lower cost. Only their doctors can write prescriptions, order lab tests, or refer to specialists. Examples include Kaiser Permanente and Sutter Health Plus.
That depends on your particular situation. Contact your insurance broker for more details. Struck Insurance Services (209-524-2893), TSM Insurance Services (209-524-6366), and Gingerich Insurance Solutions (209-524-1800) all understand the St. Luke’s Benefactor mode
A few Benefactors have tried this strategy, but it hasn’t worked very well for most of them. Everything seems to go well until we feel that the Benefactor needs a prescription, lab tests, diagnostic imaging, or a specialty consultation. For each request, we provide the Benefactor with notes of our recommendations and the patient has to make an appointment with their HMO primary care provider (PCP). After waiting for the appointment date, and only if the PCP agrees with the treatment plan, then the request is submitted to the insurance for authorization. More waiting. Finally, if the request is approved, then the patient is ready for the test or consultation. To add insult to injury, we may never receive the result without making a formal request for medical records. This kind of bottleneck ruins the convenience and timeliness that Benefactors at St. Luke’s Family Practice typically enjoy.
For the best explanation of insurance plans available you should speak to your insurance broker. Here is a general explanation from a physician’s view:
An HMO is a Health Maintenance Organization.
HMO’s try to reduce costs by using a limited panel of “highly managed” health care providers in order to provide care at lower cost. Only their doctors can write prescriptions, order lab tests, or refer to specialists. Examples include Kaiser Permanente and Sutter Health Plus. In an effort to cut costs, they will try to provide any care you need within their network; even if there might be another expert or center of excellence that might offer more advanced treatment options.
A PPO is a Preferred Provider Organization. PPO’s allow you to see any doctor, but provide a “preferred rate” for seeing doctor’s and using hospitals on their list. Since St. Luke’s will never send a bill to your insurance for care, there is no higher rate to pay for your primary care. We can write prescriptions or refer for lab tests, diagnostic imaging, and specialty consultants within your plan. Also, in case it is necessary, a PPO also allows you the freedom of seeking highly specialized care from expert physicians or centers of excellence.
Yes, but Medi-Cal plans in Central Valley counties are all HMO plans. (See the two questions immediately above.) Though we can provide your doctor visits, you are responsible for paying for all associated costs of prescriptions, lab tests, x-rays, etc. For Medi-Cal to pay for the services, only their doctors can write prescriptions, order lab tests, or refer to specialists. Despite this, some families chose to enroll their children on grandchildren as Benefactors even though they are on a Medi-Cal HMO for the convenience of seeing our physicians and their personal peace of mind.
Yes, you and your health insurance plan are responsible for all costs outside of St. Luke’s Family Practice incurred by seeing specialists, prescriptions, labs, diagnostic tests, operations, or hospitalization.
We do not draw laboratory blood tests or perform x-rays at our office.
We would never abandon a patient, but we would urge you to get covered by some other health insurance before continuing as a St. Luke’s Benefactor.
Are You Accepting New Patients?
Yes, we are happy to schedule a complimentary “get acquainted visit” with our doctors when they are able to accept new Benefactors. Also, if for any reason you later decide that St. Luke’s Family Practice is not for you, we offer a full refund of your pro-rated Benefactor fee.
We require all Benefactors to have health insurance to cover the cost of hospitalizations, surgeries, specialty consultants and testing. Being a Benefactor at St. Luke’s Family Practice is not an alternative to having health insurance.
Call our office at 209-549-1057 and our Office Manager will call you back and answer all of your questions.
Dr. RJ Heck and Dr. Erin Kiesel are our primary care physicians. Starting in January 2021, Dr. Bob Forester provides only weekend and vacation coverage.
For your first visit please bring all of the medications and supplements you are taking for your doctors to review. We will ask lots of questions about your past medical history. We will want to know about allergies or adverse reactions to medications, past operations, past diagnoses, your family medical history, and previous doctors. Please do not request all your past records before your visit. After we talk with you, we will help you chose the most pertinent records to request and review.
Even though we do not bill or collect from any insurance or government programs, we still need to have your insurance information. For example, any time we refer you to a specialist, or ask your insurance carrier for authorization for medications or diagnostic tests, we will need your current insurance information. Unlike other offices, we will not ask you about your insurance information at every visit. Please keep us informed of any changes in your insurance so that we may update your information and protect you from inconvenient delays in your care.