Medicare

OPTED OUT OF MEDICARE

The doctors at Oakhaven Health DPC have opted out of Medicare and to be a member of Oakhaven, members must have a private contract with Oakhaven agreeing to opt-out for physician services at Oakhaven. An online copy of the form can be found here.

Even though we are opted out of Medicare, that does not mean patients cannot still use Medicare for many of their medical expenses.

OAKHAVEN PATIENTS STILL USE MEDICARE FOR

Prescriptions: You can still use your Medicare Part D coverage at any outside pharmacy. While our in-house pharmacy offers deeply discounted direct-pay prices (which are often lower than a typical insurance co-pay), we will send your prescriptions wherever they are most cost-effective for you.

Laboratory Services: When we order blood work or other tests to be performed at outside laboratories (like Quest or LabCorp), those facilities can still bill Medicare directly. We receive your results electronically in our system for your doctor to review, just as before.

Imaging & Diagnostics: Medicare still covers X-rays, MRIs, and CT scans performed at outside imaging centers. While we sometimes offer onsite imaging or "direct-pay" options that cost less than an insurance co-pay, the choice to use your Medicare benefits for outside imaging is always yours.

Specialist Care: Even though our Oakhaven doctors have opted out of Medicare, we still coordinate your care with specialists. Because we maintain an active "Ordering and Referring" status with CMS, the specialists you see can continue to bill Medicare for their services as usual.

MEMBERSHIP COST

For those age 60+ the monthly membership cost is $105 per month. If a year is prepaid it is $1155 per year (one month discount per year prepaid).

This covers all doctors service fees at Oakhaven, but not supplies incidental to procedures, which are disclosed beforehand with a good faith estimate.

Neither Medicare nor supplemental Medi-gap plans will reimburse for these costs and they do not count toward deductibles. They are reimbursable from HSA/FSA funded accounts.

WHY OAKHAVEN IS BETTER

At Oakhaven the doctors can focus on what you really need medically, not what a government bureaucrat or insurance company executive decided you need**. When doctor's visits are regulated by Medicare, a patient mentioning something that was not part of their strict billing categories can trigger billing problems. Many of the rules are arbitrary and not designed to benefit the patient as much as the systems that watch over the population. For example, if a topic is brought up at an annual exam that is off-script, a patient might automatically trigger a co-pay or a surprise bill due to how Medicare requires those visits to be coded.

At Oakhaven our doctors are not billing for their care in a nickel and dime, ala carte fashion for our subscribed members. That means when they are in a patient exam with you, they are not having to think about the billing/accounting ramifications of what they are talking about or what you are talking about. It gives them freedom to be your doctor rather than a billing specialist. We're pretty sure that is what you want too!

** This statement is referring to Medicare's medical necessity criteria for reimbursement.