DOCTORS CARE PROGRAM
GROUP INFORMATION SESSION
NEW AND RETURNING APPLICANTS 2013
INTRODUCTION
Welcome to Doctors Care!
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Why are you here?
My goal today…
You need to…
Today’s session will…
Our next step after today’s session…
WHO WE ARE
Background:
Doctors Care was started by the Arapahoe Medical
Society in 1988.
This program is supported by hospitals and physicians
volunteering their time and services for medically
underserved patients.
WHAT WE ARE NOT
We are not a long term program.
Each patient over 18 has a maximum of two years of coverage in his
or her lifetime.
We are not insurance.
Physicians & hospitals do not receive any payment from us.
You do not pay a monthly amount in order to use our services.
We are not just for backdating.
This program is not intended for backdating purposes only. Therefore
to qualify for this program you must have a need for ongoing
medical care.
ELIGIBILITY AND PAPERWORK
Do you have any kind of health insurance?
We do not provide care for those who already have health coverage,
including Medicaid, Medicare, high deductible plans, etc.
If you have another sort of community program coverage (ex. CICP or
MCPN), you will be asked to quit that program in order to apply.
Do you live in our service area?
We serve patients living in Douglas, Elbert, or Arapahoe counties
excluding the city of Aurora.
Do you have a current health concern?
Because of the limited number of physician partners, you must have a
current health concern in order to qualify.
Do you have the right paperwork?
While nothing is collected today, make sure you have what you need for the
next appointment.
MEDICAID AND CHP+
REQUIREMENTS
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Medicaid and CHP+ made changes to the income guidelines and
added new programs in 2012.
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For this reason, you may be required to submit an application for
Medicaid and/or CHP+ within your first three months with Doctors
Care if it appears you or your family will qualify.
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If you are denied or waitlisted, you will keep your Doctors Care
coverage with no interruption.
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If you or your children are accepted, we will put your coverage on
hold and save your remaining time on the Sliding-Fee-Scale Program.
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Failure to apply, if requested, will result in termination from the
program until you complete the application and receive a response.
CARDS AND RENEWAL
CARDS
 The first card is issued for 3 months only.
You must pass this probation period by using the program appropriately.
 The second card is sent if there have been no problems.
This will be issued through the remainder of your 6 month eligibility period.
CARDS AND RENEWAL
RENEWAL
 Every six months you will receive a packet to continue
on the program up to your maximum of 2 years
coverage.
 If haven’t received the packet prior to your expiration
date, it is your responsibility to call us and request
another to be sent out.
CARDS AND RENEWAL
 You will only be covered for services within the dates
on your card, so follow the directions in the packet and
renew on time.
 If you aren’t using any services, call us to pause your
time on the program!
YOUR PRIMARY CARE PHYSICIAN
 The PCP’s office will serve as your Medical Home.
 You will use this physician for primary medical care and
specialist referrals.
 Start gathering your medical history paperwork now to
speed up the process, and take it with you to your first
visit.
FIRST APPOINTMENT
 Call to make an appointment with your PCP right away within
the first month of your coverage for the medical reason(s) for
which you applied to the program.
 Identify yourself as a Doctors Care patient.
 Be prepared to present your card and give your percentage
payment at time of service.
REFERRALS
 All specialist referrals must be made through the Doctors Care
office.
Have your referring physician call, fax or email Char to get the process started.
Doctors Care will notify you of the specialist’s name and phone number.
 You will be responsible for the full charge of any specialist not
assigned by Doctors Care, even if the specialist participates with us.
 Not all physicians, their services or facilities in the area are covered
under Doctors Care.
 If you are assigned to a specialist and choose not to go or cannot
afford to go, you must notify Doctors Care to cancel or put on
hold the referral. Failure to do so is considered disrespect.
No Shows and Non-Payment
 Not arriving to your appointment (or arriving
more than 10 minutes late) and non-payment
could result in immediate termination from the
Doctors Care program.
 If sent to a collection agency, the bill will return to
100% of the original charges and also will result in
immediate termination.
RESPECT
 Providers within our network are volunteers, and it is our
expectation that patients treat them and their staff with the
utmost respect.
 This includes being polite to office and medical staff, complying
with treatment recommendations, and abiding by the rules and
guidelines set by Doctors Care policies.
Not treating providers, their office and medical staff or
any Doctors Care volunteer or staff member with respect
is grounds for immediate termination.
HOSPITAL PHARMACIES
 Prescriptions are only filled when written by your primary care
provider or an assigned specialist, unless special authorization has
been obtained from Doctors Care.
 Only generics are covered.
 If brand name must be used, call our staff to apply for free
brand name medications from the manufacturer.
 A copay covers a one-month supply or one package size.
HOSPITAL PHARMACIES
See packet for addresses of pharmacies.
Plans A, B and C = $10 - Generic
Plans D, E and F = $15 - Generic
You must call at least 72 hours before picking up
a refill prescription.
OUTSIDE PHARMACIES
 King Soopers, Target and Wal-Mart have many generic
prescriptions available for $4 per month. Costco also
offers discounted drugs, even if you are not a member.
 It is up to you to decide whether or not to explore
options which may be less expensive than Doctors Care.
 Do not present your Doctors Care card at these outside
pharmacies.
CHRONIC PAIN MANAGEMENT
 Doctors Care physicians will not manage chronic pain
through narcotic medications.
 Asking any partner provider for a narcotic
medication for chronic pain is grounds for
immediate dismissal.
 We do have physicians who can perform injections and
alternative medicine providers like acupuncturists,
chiropractors and massage therapists.
BEHAVIORAL HEALTH
Patients may self-refer after seeing their PCP by calling the
Patient Care Coordinator.
Please note that although mental health medications are not
covered through Doctors Care, many low-cost options are
available.
Behavioral Health Appointment Costs through
Doctors Care Clinic
Patients are encouraged to take advantage of behavioral health
(mental health) services at the Doctors Care Clinic.
Plan A = $10
Plan B = $15
Plan C = $15
Plan D = $20
Plan E = $30
Plan F = $30
Counselors off-site may have
different pricing structures,
but are also available outside
regular office hours.
Please call (720) 458-6200 to request a referral.
SUBSTANCE ABUSE
 Our providers can screen and diagnose for drug/alcohol
dependence, but do not offer treatment or detox.
 We refer clients (when indicated) to suitable care sources.
 Ongoing support is provided.
 Doctors Care does not provide drug or alcohol
treatment at any facility, however if it is determined
that you have an addiction problem, you may be required to
follow through on a referral outside of Doctors Care to
remain eligible for the Sliding-Fee-Scale Program.
HOSPITAL USE
If you are going to be an inpatient at your assigned
hospital:
1. Check in at registration.
2. Present your Doctors Care card.
3. Pay your portion of the hospital bill represented by the
payment percentage shown on your card or arrange for
a payment plan with the hospital’s financial department
prior to your admittance.
RADIOLOGY
 Obtain an order from your doctor.
 Check in at Outpatient Registration at your assigned
hospital.
 Present your Doctors Care card at the time of service
and have your percentage payment ready.
In addition to the hospital charges, you will also receive a bill
from a radiology office (doctors who interpret the results)
afterwards. This will also be adjusted to your percentage
payment.
CT AND MRI SCANS
 Doctors Care has a special arrangement with one of
our radiology partners for CT and MRI scans.
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These are performed for the physician’s payment percentage
rate instead of the hospital’s rate, but because their base costs
are lower, this results in significant savings!
 These appointments must be scheduled through the
Patient Care Coordinator, Char.
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Have your physician contact Char instead of contacting the
hospital directly.
LAB TESTS
 Blood work is to be completed at your hospital’s lab
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only.
Obtain an order from your provider.
Check in at Outpatient Registration at your
assigned hospital, and they will direct you to the lab.
Present your Doctors Care card.
Pay your co-payment to the hospital at the time of the
visit.
ANESTHESIOLOGISTS
 Most anesthesia groups in the south metro area
participate with Doctors Care (see packet for
listing).
 After any procedure involving anesthesia, you
should receive a bill from one of these groups
adjusted to your percentage payment rate.
 Please pay this bill in a timely manner.
CHANGE OF ADDRESS, PHONE
NUMBER, OR INCOME:
 Call the Patient Care Coordinator with any changes in
address, phone number or income immediately.
Changes include:
 Address
 Phone number
 Financial or job situation
 Insurance status
 Family status
Urgent Care Needs
If you feel you have a situation that can’t wait until the
physician office opens but is not life-threatening:
 Call your doctor’s office and follow the advice given by
the after-hours provider.
 If you are told to go to the ER by this provider, it will not be
considered abuse, and you should follow all instructions given.
 After any ER or urgent care visit, you must submit a copy of
the discharge paperwork to the Patient Care Coordinator
within three business days of your discharge.
URGENT CARE IS AN OPTION
 Always call your PCP before accessing urgent care.
 Doctors Express is a much cheaper option than using the Emergency
Room, and they will also see you with less of a wait time.
 Only the Englewood location is a partner of Doctors Care.
 901 W. Hampden Ave.
 Englewood, CO 80110
 (303) 761-1699
 Open 8am-8pm 365 days/year
 $25 for Plans A, B and C
 $50 for Plans D, E and F
EMERGENCY ROOM
 Emergency room visits are expensive and designed for
true urgent emergencies only.
 If you use the emergency room, the hospital portion
of your bill will be covered, however the ER physician
cost will be completely your responsibility. These
physicians DO NOT partner with Doctors Care.
 Call us about possible ambulance bill reduction. While
they do not partner with Doctors Care, they often
are willing to give discounts to our patients.
EMERGENCY ROOM CONT.
 Inappropriate use of the Emergency
Room is grounds for termination from
the Doctors Care Program.
 If you need to be seen for a non life- or limbthreatening condition that cannot wait until
your physician’s normal hours, you must first
seek advice from the on-call physician at their
office and use urgent care if directed.
THE DOCTORS CARE CLINIC
Doctors Care Clinic provides primary care for children and young adults up to
the age of 30.
Doctors Care Clinic located at:
609 W. Littleton Blvd., Ste. 100, Littleton, CO 80120
Please call (303) 730-1313 for appointments.
Office hours for the clinic:
Monday – Thursday 9:00 - 5:00, Friday 9:00 - 4:00
Walk-ins are not accepted.
Same day appointments are generally available if needed.
Office visit co-pays:
Plan A = $10
Plan B = $15
Plan D = $20
Plan E = $30
Plan C = $15
Plan F = $30
DOCTORS CARE CLINIC
 Well-care visits and physicals.
 Children under 3 are seen more frequently for well-care visits and
immunizations.
 3-18 year olds are performed once a year.
 This office also offers well visits for young adults 19-30 years old,
something that is not offered to most adults on the program.
 Your office visit co-pay plus any lab charges are due at
time of service.
 Providers at Doctors Care have access to hospitals,
physicians, laboratories, and x-ray departments and can
make specialist referrals.
DOCTORS CARE CLINIC CONT.
 During the busy acute illness season, physicals may take
longer to schedule.
 Similar to outside clinics, you can call after hours with a
non-emergent need at (303) 730-1313 for several
advice line numbers.
NEXT STEPS
For items not covered in this presentation, see packet page 4.
Doctors Care coverage will not begin until we have received
all necessary paperwork:
 Completed application with supporting documents (one per
household)
 Patient Guidelines (yours to keep)
 Contract for Participation (one for each adult)
 HIPAA Release of Information (one for each person)
 Authorization for use and disclosure of PHI (one for
each person)
 How are you Feeling? (one for each adult)
 Medical History (one for each adult)
ADDITIONAL INFO
 Request
for resources
 Saying ‘Thank you!’
 CT/MRI
 Staff business cards
CONCLUSION
Thank you for coming today!
1.
My goal today was to teach you how Doctors Care
works and what your role will be in our program.
2.
You need to follow our rules and regulations to be
part of the program, and we’re here to help you along
the way.
3.
Our next step is to schedule a Financial Intake
appointment.