Internal Medicine Prevention and Wellness
Dr. David Miloy MD
830.895.5599 1411 Water St. Kerrville, Tx 78028

FAQ

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 Pay?

Direct Pay 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 allows us to do four key things for our patients:

1.  Time –    My staff and I are able to spend much more time with you to do a thorough job and make sure your needs are

being met as opposed to rushing you through an appointment.

2.  Access – Same day appointments and my cell phone number for after hours and weekends as opposed to the national

average of waiting 21 + days to see a doctor.

3.  Advocacy – by limiting the size of our practice we have time to coordinate your care at a very high level and fight

for the coverage of your health care services.  On average, practices like Optimum Health will save a patient

$1500-2500 per year.

4.  Innovation – We are improving the quality of how health care is delivered.  This is a constant process

which never ends and we are very excited about what the future holds.  Enhancing the patient’s experience

and health outcome is something we are deeply committed to.   Telemedicine, Rubicon MD, blog posts

and timely videos are just the beginning.  Much more is on the way.

There are no hidden fees.  Our fees are listed at the top of our webpage.

Studies show that overall patients are healthier, more satisfied and save on medical spending.  Employers are also finding Direct Pay 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 routine office expenses, 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.

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.  We will bill your insurance of Medicare for routine office services.  By doing so we are able to offer concierge medicine for a fraction of the cost.

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.  You are responsible for a minimum of six months of your monthly fee.  After that, the contract is simply month to month.  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 or Direct Pay (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.

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.  When you are sick, you will be seen.  Often times frequent office visits and close contact by phone work very well to get you through a “rough patch.”  

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.  On weekends and holidays you can reach me by cell phone.

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, saves the “system” money and improves health outcomes.

Do I still have to pay the monthly fee if I am on Medicare?

To ensure that we can spend extra time with you, give you same day access, be an advocate for you and continue to innovate we do require the monthly fee.  

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?

Medications are not covered.  If medication cost is an issue, I will work with you to find the best medicine at the most affordable cost.