BCIM Online

Frequently Asked Questions
About Concierge Medicine

Below is a list of frequently asked questions.
If you have a question not listed below,
please click here to send Dr. Espinosa an email.

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1. What services are provided as a part of my annual fee?

• Same-day or next business day appointments
• Direct phone access to Dr. Espinosa via his personal cell phone 24 hours a day, 7 days a week
• Little or no office waiting time
• Longer appointments for the most effective care
• House calls (as deemed appropriate)
• Services through state-of-the-art communication
• A strong focus on preventive medicine and long-term health and wellness
• An advocate to work directly between you and your specialist.

2. What is the mission of Buckhead Concierge Internal Medicine?

We strive to provide the highest quality medical care, emphasizing a comprehensive approach to prevention and disease management. We want patients to be completely satisfied with every aspect of their care.

3. Are you on the medical staff of a hospital?

Yes, Dr. Espinosa is on the medical staff of Piedmont Hospital in Atlanta, Georgia and Northside Hospital in Atlanta, Georgia. If you require hospitalization, Dr. Espinosa will coordinate your patient care by working with the hospital based physicians. He will also make hospital visits during your hospitalization.

4. Who will cover for you when you are not available?

On infrequent occasions when Dr. Espinosa is out of town or otherwise unavailable, he will have another concierge quality physician cover for him. Even while out of town, Dr. Espinosa will generally be available by phone to his patients and to his covering physicians. For practical reasons, we reserve the right to designate another qualified physician to perform any and all services should the need arise.

5. Do you take insurance?

PPO Patients:
BCIM is an In-Network provider for Blue Cross Blue Shield, Humana, Cigna, Tricare and United Healthcare. BCIM accepts all other insurance as an Out-of-Network provider. We, however, do not participate in Medicaid. Regardless of your plan, we will continue to bill your insurance for all covered services. It is our intention that no insurance-covered medical services are included in your annual fee.

Medicare Patients:
BCIM participates fully in the Medicare program. Per Medicare regulation, the annual exam benefit portion of the Concierge Service cannot be included for patients who are new to Medicare in a given year. As of January 2005, Medicare established a one-time reimbursement to physicians who offer the “Welcome to Medicare” exam to new Medicare patients. This exam must be billed to Medicare except for any Medicare co-pay, for which the patient will be responsible. Please advise us if you have recently turned 65 when you sign on with the practice. It is our intention that no insurance-covered medical services are included in your annual fee.

HMO/Medicare HMO Patients:
HMO patients will not be able to join the practice until they transition to either a PPO or traditional Medicare plan.

6. Do I still need insurance if I enroll with you?

Yes. Concierge medical practices do not take the place of general health insurance coverage. Buckhead Concierge Internal Medicine is a primary care medical practice, not a health insurance program. You are advised to continue your PPO, Medicare or other insurance program. If you are an uninsured individual and desire to enroll in the practice, we will provide you with a discounted fee schedule for office visits, tests and procedures.

7. Will my insurance still be billed for my office visits?

Yes, we will bill your insurance company directly. The purpose of your concierge fee is to ensure easy access to your physician and the practice. It does not cover costs for regular exams or testing conducted inside or outside of the clinic.  These are billed to your insurance provider.

8. Is there a co-payment?

If you have PPO insurance, we will collect the co-payment at the time of service. Medicare patients usually do not require a co-payment.

9. Do you bill Medicare for the annual concierge fee?

No. The annual concierge fee only includes services that are not covered by Medicare and, as such, cannot be paid for or reimbursed by Medicare. We will bill Medicare for your sick visits and for any additional services performed at this practice that ARE covered by Medicare.

10. Will my private insurance reimburse my annual concierge fee?

No, private insurance does not typically reimburse for the annual concierge fee. However, some Flexible Spending Account and Health Savings Account plans may pay for all or part of the annual fee. Members are advised to consult their human resources representative at their place of employment.

 

11. Is the annual concierge fee tax deductible?

In many cases the concierge fee is a tax deductible healthcare expense. Patients are advised to consult with their tax consultant to clarify qualification in their particular circumstance.

12. What about lab, x-ray, specialists’ fees and hospitalization?

Your annual fee pays for membership in the practice and the associated amenities. However, procedures and services not performed in the Buckhead Concierge Internal Medicine office will be billed by the performing entity and should be covered as determined by the patient's insurance or the performing entity's billing practices.

13. Are there age limits?

Dr. Espinosa is an Internal Medicine physician. His specialty is Adult medicine. Dr. Espinosa is trained to manage acute and chronic medical illnesses among adults. As such, the practice is limited to patients 17 years of age and older.

14. What if I have an emergency?

If you have a life threatening emergency, call 911 immediately. After you call 911, please call Dr. Espinosa. He will attempt to coordinate your emergency care thereafter. Patients are asked to contact Dr. Espinosa before going to any urgent care facility and at any time of the day or night. Dr. Espinosa will attempt to address urgent after-hours problems directly.

15. How far in advance do I need to book an appointment?

Dr. Espinosa is committed to providing his patients with easy access to care. All urgent visits will be accommodated either same day or next day, placing the greatest priority on the sickest patients. Annual physical exams will be booked 1 to 2 weeks in advance.

16. What do I do if I become ill while traveling or away on an extended vacation?

Call 911 if you have a life threatening emergency. Then call Dr. Espinosa. Call Dr. Espinosa first if the problem is minor. With the exception of a few controlled substances, most prescriptions can be ordered anywhere in the country. If necessary, it may be possible for Dr. Espinosa to find you a resource in your area. If you seek care at an emergency room or urgent care center out of our area, we request that you have the doctor seeing you call Dr. Espinosa for coordination. Dr. Espinosa will be readily available by phone for consultation with you and/or other health care personnel. If you should require hospitalization while away, at your request, Dr. Espinosa will establish phone communication with you and your attending physician(s) to ensure continuity of care.

17. Do you make house calls?

House calls will be available to BCIM members on an as-needed basis and within a limited radius from the clinic. These will be done as deemed appropriate by Dr. Espinosa on a case-by-case basis. Home visits will be charged as an office visit would.

18. What if I need to see a specialist or a surgeon?

Of course, Buckhead Concierge Internal Medicine patients are free to see any specialist they wish. We are available to help you decide what specialists to see and to coordinate such consultations. In this way the most appropriate resource is used, the earliest arrangements are made, and your applicable medical information is sent in advance of your specialist visit.

19. What about the cost of prescription medications?

The cost of prescription medications are the patient’s responsibility and in most cases should be covered by their insurance plans. We have expertise in assisting patients in purchasing medications in the most cost effective manner.

20. Will I be required to pay my annual concierge fee even if I do not use your services?

Yes. Paying your concierge fee allows you to be a member of the practice whether you are sick or well. However, Buckhead Concierge Internal Medicine is not an insurance company and does not cover the medical services you receive. We strongly encourage you to utilize the amenities offered including wellness consultations and emails for appropriate non-urgent health related questions, regardless of your state of health.