During the intake process, patients are provided guidelines on participation in the program, including:
Patients sign a contract to confirm their understanding of the rules and guidelines and the fact they can be terminated from the program for non-compliance. For example, a patient going to the ER without approval from their PCP is considered in violation of program rules. Partner providers are instructed to contact the Patient Care Coordinator for any problems, which we then address directly with the patient.
Patients who violate the program rules are given a warning or “strike” against their account via warning letters and personal phone calls. We discuss the violation with the patient, what can be done to correct the problem and how to handle future situations. Education, along with warnings, is essential for patients to continue learning better utilization of the health care system.
If a patient receives three strikes, they are dismissed from the program with a one-year penalty period before being allowed to re-enroll. Additionally, certain behaviors can cause patients to be immediately dismissed with one strike (e.g., their financial account being sent to collections, falsifying or forging a prescription, providing false information or being dismissed from a practice).
While providing direct services to patients, Doctors Care also strives to teach them self-sufficiency within the health care system. Through education about the proper use of the medical system and connecting patients to additional community support sources, Doctors Care encourages patients to become their own long-term health care advocates, and to integrate into the system as they are able.
By assigning each patient a primary care provider to serve as a medical home, and drawing parallels between the Sliding-Fee-Scale Program and some forms of health insurance, Doctors Care models effective use of the health care system for its patients.
Patient payment is based on the assigned percentage of total charges that would be typically submitted to an insurance company. Payment is required to the medical provider at the time of service, or a payment plan may be set up prior to the visit for large procedures or surgeries. All patients pay a minimum of $10 per visit, even if their percentage equals less.
Non-payment at the time of service, or by the due date of a pre-arranged payment plan, is grounds for termination from the program. Any bill sent to collections will result in a reversal of the discount, meaning the patient becomes responsible for 100 percent of the charges and will be immediately terminated from the Doctors Care program.
That said, we request medical providers/billers contact us whenever possible before sending a patient to collections. This allows us the opportunity to provide a warning, along with education about how to handle payment. We request the biller allow two weeks for the patient to pay their portion, or set up appropriate payment arrangements. If the patient follows through, we allow them to stay on the program.