Typical Questions About Membership Medicine
What is Maitri Wellness?
Wait, what?! Are you serious?
What is direct primary care?
Direct primary care is a healthcare model focused on putting the patient first without any interference from insurance companies. That means I treat patients when they need it, never rushing patients through appointments, and I am proactive with healthcare treatment plans. Your relationship is with me, your doctor, not with your insurance company.
Direct primary care clinics do not accept insurance. Patients pay a convenient and affordable flat monthly fee. Direct primary care doctors choose to work directly with the patient. The number of patients I see is limited. Instead of the typical 1500-3000 patient panel that a primary care doctor must carry in order to have a viable insurance-based practice, a typical full panel for a DPC practice is 600 patients. At this time, I am limiting my practice further to only 200 patients. I have the privilege of knowing all of my patients and can take the extra time to focus on your wellness.
Is concierge medicine the same as direct primary care?
The terms are often used interchangeably but there are some general philosophical differences. Concierge or ‘boutique’ practices tend to charge larger monthly or annual fees AND continue to bill your insurance, which limits the affordability of these practices for many people. DPC practices are designed to offer many of the same benefits of a concierge-style practice, but at a more affordable price – one simple fee, no co-pays, no deductibles. For the cost of a Starbucks drink per day, my patients have access to personalized, quality care from a board-certified physician.
What sets Maitri Wellness apart from other practices?
At Maitri Wellness, I have shrugged the bureaucracy. I have shredded the red tape. I refuse to recognize any interference with the physician/patient relationship, and in doing so we have returned family-practice medicine to its root values: clinical excellence for and compassionate knowledge of every patient.
In every aspect of family healthcare, I promise accessibility, convenience and affordability. In addition, I provide an integrative outlook and incorporate this often even in my regular visits. Often treatment recommendations include medications, but also other modalities such as yoga, meditation, lifestyle change, acupuncture and other treatment drawn from Ayurveda, Traditional Chinese Medicine and Functional Medicine.
Will I benefit from Maitri Wellness if I don’t require frequent medical attention?
Of course! Everyone benefits from a service tailored directly to him or her, and if you’re healthy I aim to keep you that way! That’s why I offer personalized healthcare. My practice is devoted to the maintenance of your good health, and to enhancing your life in a way that only physical well-being can bring.
There are two levels of membership, based on how much you come in to see the doctor, and this can help tailor the level of your membership to what you need.
In wellness and therapeutic care alike, Maitri Wellness’ great ally is time. You won’t spend large amounts of time on hold or waiting in the waiting room. You will spend more time with me and build a relationship with me. When you visit, I will answer your questions and meet your needs in a way that helps you stay relaxed. Over time, as I learn more about your changing health, our long-term relationship will provide invaluable understanding and an impeccable level of care.
I will have the time to get to know you and your unique story, which will make me ready to handle any health challenges that you face over time. As part of my practice, you’ll have access to the resources to create a personalized health plan that can help us identify risk factors and issues, hopefully before they become problematic.
How does insurance work at Maitri Wellness?
Does Maitri Wellness bill health insurance plans?
Perhaps the most critical distinction in this model of care centers on a direct, personal relationship between you and your doctor—there is no insurance company involvement in determining the course of your care. You and I make your choices together. This direct fee-for-services arrangement frees us from the typical contractual agreements that prevent physicians from offering wholesale prices on laboratory tests, imaging and medications. You will NOT be charged for office visits or co-pays. You pay only your monthly membership fee.
This model results in significant savings: money, paperwork and time. The membership fee allows us to keep the overhead low, the practice small, and I work directly for the patients, not the insurance company!
As a patient of Maitri Wellness, will I still need health insurance?
Yes. I recommend that my patients continue to carry both a major medical plan and a health savings account to ensure financial help to cover expensive, unusual and unpredictable events such as surgery, specialist care, emergency care and hospitalizations, when necessary. I’m happy to refer you to insurance representatives who can help customize an insurance plan to your specific needs.
Your everyday primary, preventive care, however, will not require insurance.
Can you help me find affordable insurance for my family or my business?
Absolutely. I’m fortunate to connect with the people in the community who can build custom, streamlined plans and offer other options to help cover your healthcare costs.
Can this model of practice actually save me money?
For many of my patients, it is very likely.
As a primary care practice, Maitri Wellness can handle the vast majority of your health issues and concerns. Studies show this direct model of care reduces the need for unnecessary medications, expensive testing and unnecessary specialist referrals. It is more likely to prevent unnecessary emergency room visits and hospitalizations. This results in saving you money and providing you better care.
By switching to a high-deductible, low-premium plan, I can help many of our patients save money.
If I have Medicare, can I still join Maitri Wellness?
Yes, although Dr. Kaul has opted out of Medicare, you are still free to join our DPC. Medicare will cover any laboratory testing, imaging, medications, durable medical equipment (DME), or hospitalizations prescribed for you. Medicare will not cover your monthly membership fee.
Can I still join even if I don’t have insurance?
Yes, you can, although I recommend that you have health insurance to cover potentially large expenses from things such as cancer treatment, heart attacks or accidents in which you are injured. I am your primary care physician. You may have other medical needs I cannot meet
Is my membership to Maitri Wellness tax deductible?
It is not.
Your retainer is not yet defined as a “medical expense” in most states, and as such it is not tax-deductible. The American Academy of Private Physicians, however, is lobbying hard to win rightful deductibility for these expenses. In the meantime, consult with your tax consultant to clarify tax consequences in your particular circumstances.
Why should I join when my insurance already covers primary care?
Health insurance typically offers partial reimbursement for care and you are responsible for copays, co-insurance and deductibles. In addition, availability of your doctor and long wait times for appointments are factors that may influence the quality of the primary care that you receive. As your doctor, I dedicate my time to your health to the extent that you may feel like you are my only patient.
Are there any additional fees, copayments or deductibles?
There are no copays, deductibles or additional fees for basic services. Acupuncture and some GYN procedures may have additional fees. You will be aware in advance of any additional costs and can decide if you want to proceed.
Why don’t you accept health insurance?
My goal as your doctor is to work for you, not your insurance company. By not accepting health insurance, I can treat you to the best of my ability in a way that benefits you most—without interference from insurance companies.
How appointments and referrals work
How are your appointments set up?
Appointments can be made by calling or texting me. Appointments start promptly and end on time. This minimizes wait time for you and other patients.
Do you see me if I’m in the hospital?
Yes, I will. Hospital admissions for serious medical problems are very stressful and often confusing for patients and their families. I will work closely with hospital staff in the event of an admission, to make sure your healthcare needs are being met.
Do you make home visits or nursing home visits?
Yes, I do. I will see patients in their home or nursing facility, rehab facility or Assisted Living Facility in medically appropriate situations. This decision is made on a case-by-case basis.
What if I need a specialist?
As your primary care physician, my extensive training allows me to handle most of your health care needs. However, in the event that you do need to see a specialist, I will find the right doctor for you and make sure you are comfortable with that choice. This referral process will include direct physician-to-physician consultation prior to your appointment with the specialist and direct coordination of your visit.
And after your appointment, if you have any questions or concerns about your visit with your specialist, I will address these issues.
Can children become members of Maitri Wellness?
Yes! Visit up for checkups, fevers, sore throat, stitches, scrapes and bruises, and vaccinations.
Can I contact my physician after hours? And how?
Yes! Because illness and injury do not respect regular office hours, you may call me any day, at any hour, as long as it is truly an urgent matter.
For problems that are urgent, but not medical emergencies, you can contact us at any time. In many cases, I can diagnose and treat your need without a visit to the ER. In fact, private medicine has been shown to result in fewer ER visits for members because we can discuss your medical needs any time of the day or night.
If you have a life-threatening emergency, call 911 immediately. A family member or caregiver can call me later to alert me of your situation so I can be in contact with the emergency room.
What if I need medical attention while I’m away from home?
Naturally I provide such care. Because I know you well, I can streamline your care when you’re sick away from home. Many illnesses can be diagnosed and treated with a simple conversation by phone, email, text or webcam. I will locate the nearest pharmacy and order the medications most appropriate for your circumstance
What if you are on vacation?
As a member of Maitri Wellness, you are never alone. Even when out of town, I will still be available by phone for your urgent needs. You will be notified by email prior to any vacations. If I am not available, I will always have another trusted physician available to assist you for any urgent matters or to be seen in the office.
Are my medical records ever shared with insurance carriers or pharmaceutical companies?
No. I maintain scrupulous standards of privacy. I am never obligated to provide any third party with a copy of your records, unless you specifically ask that I do so.
What does the membership plan include?
Your membership covers all of the primary care services I offer in the office. This includes in-office visits, home and extended facility visits as necessary, hospital visits, minor office procedures, EKGs, diagnostic and wellness exams, phone calls, video conferencing and arrangement to see specialists with direct-doctor to-doctor communication.
I will be available when the office is closed and you will have my direct phone number. When you call the office, there will be no long wait only to be blocked by a receptionist. Your messages will be responded to promptly.
You will be able to communicate via phone, text, or email and all of this communication will be saved directly to your chart.
You will enjoy greater convenience and peace of mind, and you may also find a reduced need for visits to specialists and the emergency department.
Click here for a list of the many services you will receive.
Who does this membership plan work best for?
It works especially well for those who want to participate in improving their health and staying well, including:
• Patients desiring easy and direct communication with their doctor.
• Patients who want a doctor to address the root cause of illness, not just treat the symptoms.
• Those with high insurance premiums, high-deductible health plans or no insurance.
• Self-insured businesses seeking to provide their employees with affordable health care while improving their well-being—while simultaneously reducing health care spending.
• People with an interest in alternative medicine.