A: Yes, there will be no other routine charges from my office beyond the comprehensive annual fee. Refer to the "Scope of Services" outline for more details.

A: No, one of the assumptions of luxury primary care is that patients will retain their health insurance coverage. Your health insurance will continue to reimburse you for the cost of medical services that I cannot provide, such as lab and x-ray studies, hospital costs, subspecialty consultation and care, etc.

A: Medicare forbids physicians from collecting fees which exceed its mandatory charge limits. Therefore, Medicare cannot be billed and you will not be reimbursed by Medicare for this annual fee. In order to offer luxury primary care (LPC) services I must resign from the Medicare program. While some LPC practices may continue to bill Medicare in addition to their annual fees, there is concern that this practice will be held in violation of Medicare rules.

A: No, your Medicare benefits will not be affected by your participation. Medically-necessary services that I cannot provide (such as lab, x-ray, hospital costs, other doctors’ care, etc.) will continue to be covered by Medicare and any secondary policy that you might carry.

Q: Can you bill private insurance carriers or secondary insurance for your services? Is this fee tax-deductible?

A: Yes, I will be happy to file claims for you with private insurance carriers for this annual fee or on a fee-for-service basis, upon your instructions. Naturally, any reimbursement from your carrier will be determined by the provisions of your health care policy. Consult with your tax adviser to determine if this fee qualifies as a deductible medical expense in your case.

A: The annual fee is the same for all patients, as is my year-round duty and commitment. I realize that many patients live in their desert homes for only part of the year, and that these patients are likely to benefit most from my care while in residence in the desert. However, having a personal primary care physician who is always available has year-round advantages. I will continue to be actively involved in each patient’s medical care from any distance, and will regularly communicate with patients and collaborate with any hometown physicians to assure optimum quality and continuity of care.

A: The "annual physical," although beneficial, may not be sufficient to provide for a patient’s unpredictable medical care needs. If you should become ill, the availability of personal physicians in our community is limited. Rather than just a once-a-year snapshot of your health status, my practice offers immediate access to superior year-round care whenever you need it. Because I will be the private physician for only a small number of patients, I can offer a level of personal attention unavailable in a conventional primary care practice. Patients joining my practice will receive something of value in return: confidence in me as their physician; peace of mind that they will receive an immediate response if they have medical trouble or questions; assurance that the hassles, headaches and delays that they now encounter while negotiating the medical system will be taken care of for them.

A: Because the majority of practice expenses are incurred on an annual basis, one half of each patient’s annual fee is nonrefundable. The remainder of the fee will be refunded on a prorated basis (by month) in the event of a patient’s withdrawal from the practice, or should it become necessary to close the practice. If a patient is asked to leave the practice, a prorated refund of the entire annual fee will be provided. Because medical care is typically most intensive near the end of life, no refund will be provided in the event of a patient’s death.

A: I will be available to my patients 365 days a year, an unprecedented professional commitment made possible only by the restricted number of patients under my care. Outside of office hours, your calls will always come directly to me, either via pager or cellular telephone, and my response will be immediate. For minor or routine problems, triage or treatment can be performed over the phone. If you need to be seen, I will see you at any time. Only when I am out of town or on vacation and not physically able to attend you, will I arrange for another excellent internist to provide for your hands-on care needs. Other luxury primary care (LPC) practices have succeeded as partnerships of two or more physicians. At present I have no such plan. I intend to always preserve one major benefit of the LPC model: the consistency and security of a dedicated personal physician.