How Do I Become an Optimum Health Member?
It’s simple, call (830 895-5599) or drop by our office (1411 Water st, Kerrville) to sign up.
Can I meet with Dr. Miloy before signing up with Optimum Health?
Yes. I encourage you to call the office and let our receptionist know you would like to meet me. It’s important you feel comfortable with joining our practice and feel confident we can meet your healthcare goals/needs.
What is Direct Primary Care?
Direct Primary Care is comprehensive primary medical care and prevention services. It is a direct agreement between the doctor and patient. There is an affordable monthly fee that covers all of the doctor’s services. There is no co pay or hidden fees. Our fees are listed at the top of our webpage.
The doctor works directly for you and is not restricted or burdened by an insurance company. This means I have more time to spend with you. Studies show that Direct Primary Care patients overall are healthier, more satisfied and save on medical spending. Employers are also finding Direct Primary Care to be more affordable and helps their employees to be more productive.
Will my existing health insurance cover my monthly fee?
Traditional health insurance does not cover the Optimum Health monthly fee. It will continue to assist you with specialist care, medication, hospitalization and lab testing.
Otherwise, Optimum Health works well with insurance because you will receive exceptional care with an emphasis on prevention and wellness. Therefore it is likely you will have less overall medical expenses. This is particularly important with the high deductibles that are becoming more common place.
How does Optimum Health work with specialists?
We are able to offer enhanced coordination of care with specialist. I will work with your specialist(s) to ensure they have all the necessary medical information about you so they can provide you with the best care possible. I often speak with them personally to make sure your care is being coordinated at a high level.
Part of my job description is coordinating your care and being an advocate for you.
Specialist fees are not covered by the Optimum Health membership, but are covered by Liberty Direct or your private health insurance.
How is Dr. Miloy able to offer “Affordable Concierge Care?”
I will be limiting the number of Optimum Health members. Once we reach that limit we will not accept new members. Most primary care physicians in Texas have four to eight times as many patients than I will accept. Therefore I will have more time and resources to deliver your care. Because there is no insurance billing involved we are able to pass those savings along to our patients.
Is there a contract to sign?
Yes. There is a physician – patient agreement. I encourage all potential members to read the agreement. The language is straightforward. It includes a list of our services and membership fees. It’s important you are educated about your health care and understand there is no hidden agenda with our program. After the first six months you may discontinue your Optimum health membership at anytime with no financial penalty. The six month mark is chosen because we invest in you during the initial sign up process by collecting, studying and documenting your past medical history. We also will conduct a comprehensive physical exam. We will also perform testing in our office (see “Benefits”) at the top of our webpage.
Is Direct Primary Care considered insurance?
Direct Primary Care (Optimum Health) is not considered insurance by Texas state law HB 1945 which was passed into law on May 28th, 2015.
” House Bill 1945 amends the Occupations Code to establish that a physician providing direct primary care to a patient in return for payment of a direct fee is not an insurer or health maintenance organization nor subject to Texas Department of Insurance (TDI) regulation for the care. The law prohibits a physician from billing an insurer or health maintenance organization for direct primary care that is paid under a medical service agreement, establishes that such an agreement is not health or accident insurance or coverage nor subject to TDI regulation, and establishes related disclosure requirements. The law prohibits the state, a health insurer or health maintenance organization, or a health care provider from interfering with a physician or person solely because the physician provides direct primary care or the person pays a direct fee for the care.”
Do I still need to keep my health insurance and/or Medicare?
Yes, your insurance and/or Medicare will still be billed for normally covered services rendered by Dr. Miloy and his staff. Additionally outside of Dr. Miloy’s office, you will still need medical insurance for emergency room visits, hospitalization, specialists, prescriptions and all services provided outside of my office.
Are you limiting the number of patients who can become members?
Yes, due to the nature of the Direct primary care practice, where I plan to devote more time and attention to each patient who joins, membership will be limited and offered to patients on a first-come, first-serve basis. This way, I can ensure each patient who becomes a member will receive the highest level of attention and care possible. Priority will be given to established patients.
If I become a member of the Direct Primary Care plan, how often am I allowed to see my doctor?
There are no limits on the number of times that you can be seen for medical conditions.
Can I make same day or next day appointments?
Yes, same day appointments are available for members who call the office before 12pm noon, while next day appointments will be scheduled for patients who call after 12pm noon.
Will by secondary insurance cover the monthly fee?
Unfortunately no. Hopefully, in the future Medicare and private insurance will assist with the monthly fee. As this approach to primary care reduces hospitalizations and improves health outcomes.
Do I still have to pay the monthly fee if I am on Medicare?
Yes, you will be required to pay my annual fee. We will bill Medicare for medical services rendered.
If I'm an existing patient, does the monthly fee replace the $275 fee for my annual exam?
Yes. That fee goes by the wayside the moment you sign up.
Is the cost of prescriptions covered or discounted through my monthly fee?
No. I will always prescribe less expensive generic brand medicines when deemed appropriate.