Frequently Asked Questions

 

Q:  How much does it cost to be a member of Appleton Clinics?

A:  $79 per month per adult, billed directly each month to your credit/debit card. Adult members may add up to two children 25 and under free per family.  Additional children are only $10 per month each.  A one-time $99 registration fee per adult will be included in your total initial charges. You may cancel at any time.  If you re-enroll at a later date there will be a $99 re-enrollment fee. Your enrollment is always subject to limited space availability at the clinics.


Q:  How does this work with medical insurance?

A:  If you have Medicare, Medicaid, or even if you have the best health insurance on the planet it doesn't mean you'll have great access to a great doctor.  In fact, you still may not even be able to find a doctor!

That's why many of our members are pairing their Appleton Clinics membership with a higher deductible plan (or lower cost supplement).  With this strategy members gain access to all of the services at Appleton Clinics and can often save a significant amount on their monthly health insurance premiums.  They also save by avoiding insurance deductibles, co-pays and out-of-pocket expenses for the services provided at Appleton Clinics.

Even though Appleton Clinics does not require or accept any type of insurance, including Medicare or Medicaid, we highly recommend speaking with one of our membership specialists to discuss your specific situation.


Q:  How do the doctors have time to offer "unlimited" primary care services?

A:  Appleton Clinics doesn’t accept insurance or the headaches that come with coding, billing and reimbursement. We've also limited the amount of patients per doctor to about one-third the normal primary care practice. That frees up our doctors to spend far more quality time per patient and far less time hurrying appointments and hassling with insurance companies. 


Q:  Are my medical records ever shared with insurance companies or the federal government?

A:  No. We will never provide any third party with a copy of your medical records unless you specifically ask that we do so.  Your private health information is between you and your physician, as it should be.


Q:  What about pre-existing conditions?

A:  Appleton Clinics happily accepts patients with pre-existing conditions, provided that our doctors believe they can do an outstanding job of helping you with your particular condition(s).  When you apply for membership you will be given a new patient questionnaire for one of our board certified family physicians to review.  You will be contacted if they have any questions before your registration is processed.


Q:  What if I don't have medical insurance?

A:  You can still join Appleton Clinics!  Many of our patients do not have medical insurance, but they still joined Appleton Clinics for affordable access to our  primary healthcare services.  Although we recommend carrying medical insurance for the medical services we don't provide (specialists, surgery, hospitalizations,etc.), you are still more than welcome to join Appleton Clinics!


Q:  Can I have just my child on a membership?

A:  Children without an accompanying adult membership will be charged the same registration fee and monthly membership fee as an adult.


Q:  Do you have enough doctors?

A:  Yes, and more are joining us!  Each time you visit you will be seen by a highly-qualified board certified family physician (no appointments with nurses or physician assistants), and Appleton Clinics also has additional doctors on call should the need arise.    


Q:  Is this health insurance?

A:  No.  Think of our services like a gym membership -- you are paying for access to the clinic and the services we provide, but how much you use of it is up to you.  As always, it's important to remember that your membership fee does not cover third-party services such as specialty care, emergency room visits, hospitalizations and other healthcare related goods and services that may be covered by a health insurance plan. We strongly recommend patients purchase or maintain sufficient health care insurance to meet their individual needs above and beyond the services provided by Appleton Clinics.


Q:  Why doesn't Appleton Clinics accept health insurance?

A:  We have found that family physicians spend way too much time, effort and resources complying with insurance requirements.  At Appleton Clinics our doctors don't spend time coding, billing and seeking insurance company reimbursements.  They spend their time with patients and focus on their personal wellness. 

This also means our doctors do not need to seek permission from an insurance company to order the tests they think are necessary for you, and it allows us to work directly with labs and pharmaceutical companies to negotiate wholesale prices.


Q:  Is there a long-term contract?

A:  No. You can cancel at any time and there is no cancellation fee. However, there are no refunds for fees already paid.  If you choose to re-enroll at a later date you will pay a one-time $99 re-enrollment fee. And because we limit the number of patients at our clinics, we cannot guarantee there will be room to accept you at a later date.


Q:  Can I become an Appleton Clinics patient if I am covered by Medicare or Medicaid?

A:  Yes, however Appleton Clinics membership fees and services are not reimburseable by these programs and we do not submit claims to any insurance provider.  As a member you will be required to sign opt-out paperwork preventing services provided by the clinic to be submitted for reimbursement from Medicare or Medicaid.


Q:  If I am in a managed care healthcare plan currently, may I join Appleton Clinics too?

A:  Yes, your Appleton Clinics fee provides you with Appleton Clinics primary care regardless of your insurance or managed care plan. Your managed care or your health maintenance organization (HMO) may refuse to pay for any goods or services that are not ordered by one of their providers.


Q:  What’s the difference between this and concierge medicine?

A:   "Concierge medicine" is a term used to describe a medical practice where typically wealthy patients pay a premium costing upwards of $1,500 - $6,000 per member per year simply for the privilege of seeing their doctor.  Concierge medicine does nothing to make the healthcare system more efficient.  With concierge medicine, insurance is still billed and inflated retail prices are still paid for goods and services provided.


Q.  Is this some kind of a political statement?  Doesn't this fly in the face of Obamacare? 

A:  Absolutely not!  Our motivation is not political, it's to help improve primary healthcare delivery for our patients. There is actually a provision in the Affordable Care Act to take our type of approach to delivering high-quality primary care, because it was recognized this approach could actually provide high-quality care while reducing overall costs.  And in fact, several "direct primary care" practices around the country have proven they can provide higher levels of care while reducing costs.  We've studied them, and believe we've taken the best practices from each and wrapped them into Appleton Clinics.  We believe the approach we take at Appleton Clinics provides the best primary care at the lowest overall price.


Q:  Isn't the concept of having patients pay for service outside of an insurance-based system going to select out the rich people for good care?  How is that fair?

A:  Absolutely not.  Unlike other models, Appleton Clinics is designed to actually reduce the costs of services provided to you.  And, most healthcare plans have fairly steep deductibles, so most people are still worried about the affordability of their first out-of-pocket health care dollars.  With a $2,000, $5,000 or even $12,000 deductible it doesn't take too many visits to an insurance-based practice or even a single trip to the ER for some stitches to be out-of-pocket more than an Appleton Clinics member would be for an entire year of membership.


Q:  What if I'm on vacation or out of town and I get sick?  Am I just on my own?

A:  No.  We realize that patients get sick or injured when they're traveling, or on vacation, or in Arizona for the winter (Lucky!).  If you need medical advice and you're not in town, we are easy to get ahold of, and we want to help you get better.... fast!  We invite you to call our physicians and ask questions, or to text us a picture of the rash on your neck, or the cut on your hand, or the interesting new way that your knee bends since you crashed on your snowboard.  Sometimes we can call in an antibiotic to save your trip, maybe you need something for your migraine, or maybe you need to be told by YOUR doctor that you need to go to the nearest ER.  Or maybe you just need reassurance that it's going to be alright.  We can help you with any of those.


Q.  What if I need lab work?  Isn't that going to be really expensive?

A:  We doubt it.  We have formed relationships with some of the top local and national laboratories and we have a direct pricing agreement in place with them.  Suddenly your thyroid test that used to be $128 is under $10.  Your cholesterol panel that had been $85 is now $12.  Your Diabetes test that had been $65 is now $10.  Does it suddenly feel like you've been paying way too much for lab work for most of your adult life?  Well, we think you have.  Welcome to Appleton Clinics!


Q.  If I need x-rays, isn't that going to be expensive?  I had one last year on my wrist and I think it was around $300. 

A:  Definitely not.  Plain x-rays are included in your membership fee, and we have relationships with radiologists who can read these the same day. It doesn't take too many falls on the ice for an Appleton Clinics patient to be comfortable removing "X-Rays" from the family budget!  (But we still recommend you be careful when walking on ice!).


Q.  What if I need an expensive radiology test, like an MRI or a CT scan?  Does Appleton Clinics have their own MRI machine?

A:  No, happily, no.  MRI machines can cost over a million dollars, so you don't want us to have our own MRI machine that you have to help pay for.  Instead, we partner with hospitals and physician offices who already own MRI machines and CT scanners and ultrasound machines who are willing to pass along wholesale pricing to our patients for as low as $500 or less. Suddenly that CT scan you had on your belly last summer in the ER that cost $4,500 sounds a little pricey doesn't it?


Q.  I only go to the doctor once or twice a year.  Why would I want to pay for service all year long? 

A:  We think the reason that a lot of patients don’t go to their doctor very often is because the whole experience can be so painful.  Who really wants to explain why they need to see the doctor to a receptionist on the telephone?  Who wants to wait for a week (or three) for an appointment?  Who wants to sit in a lobby for half an hour reading an out of date Newsweek magazine?  And if you make it through that, who wants to see a frazzled physician who’s already 20 minutes behind schedule for 7 minutes, and then receive a bill that’s too high 3 months later?  We think if it were easier, less expensive, more private, and less hassle, that patients wouldn’t be so hesitant to see their doctor.  And, then we might talk to our doctor about issues that are on our mind, and not just when we’re feeling miserable.