Frequently Asked Questions:

What Is The Direct Care Fee-For-Service Model?

The direct care fee-for-service model emphasizes a patient-centered approach, enabling physicians to dedicate more time to their patients and provide highly personalized care. Patients pay directly for their doctor’s services, minimizing Medicare-related administrative burdens, and fostering simplicity and transparency. This approach strengthens the doctor-patient relationship, ensuring you receive the focused and individualized care you deserve.

Why Is Dr. Russell Weg Making This Change?

Healthcare delivery has undergone significant changes over the years. Medicare costs have increased due to rising premiums, deductibles and out-of-pocket expenses. Meanwhile, beneficiaries have experienced reduced coverage for services, along with increased restrictions that reduce access to care and transparency. 

Medicare physician reimbursement rates have also dropped by 29% since 2001, with more than a 6% decline in the past three years alone. At the same time, growing restrictions and regulatory demands have relegated practices to spending approximately 75% of their time on administrative and insurance-related tasks, leaving just 25% for patient care. This shift has transformed the practice of medicine from a collaborative effort between patients and doctors to one increasingly controlled by administrators.

These changes have caused physicians to join larger healthcare systems or transfer care to physician assistants and nurse practitioners. As a result, costs have risen, the distance between patients and their doctors has increased, and the overall quality of care patients receive has declined. Patients in such systems frequently find themselves wondering, “When was the last time I actually saw my doctor?” This is not the way medical care was intended to be delivered. 

By transitioning to a direct care fee-for-service model, Dr. Russell Weg will be able to dedicate more time and energy to delivering high-quality, personalized care tailored to your specific health needs—without the limitations imposed by Medicare requirements.

We believe this transition to a direct care fee-for-service model will bring the following benefits:

1. Improved Quality of Care: The direct care fee-for-service model enables Dr. Russell Weg to spend more time with each patient, offering a comprehensive and tailored approach to your healthcare needs.

2. Enhanced Access to Services: Dr. Russell Weg’s office can streamline administrative processes, reducing delays and focusing on providing timely care.

3. Greater Patient Satisfaction: You will have a doctor unbound by Medicare constraints and know that you are receiving the highest quality of care. 

4. Greater Transparency: You will have a clear understanding of the costs, empowering you to make informed decisions.

When Do These Changes Take Effect?

Dr. Russell Weg will begin seeing Medicare patients via a direct care fee-for-service model beginning April 1, 2025. As per Medicare requirements, Dr. Russell Weg will be considered an out-of-Medicare provider at that time.

What Does It Mean That Dr. Russell Weg Is Out Of Medicare? Can I Still See Dr. Russell Weg If I Have Medicare? 

Yes, you can still see Dr. Russell Weg. To practice under the direct care fee-for-service model, Medicare requires Dr. Weg to function as an out-of-Medicare provider. This means that he cannot bill Medicare for his services. Instead, patients pay for his services directly at the time of their appointment. Medicare does not allow patients to seek reimbursement for these payments. However, bloodwork, imaging and medications will continue to be covered according to Medicare policy.

What About Medicare Advantage Plans?

These changes apply to both traditional Medicare and Medicare Advantage plans. If you're uncertain whether this change impacts your coverage, please contact your insurance company. Our office is also here to help.

What If I Have Secondary Or Supplemental Insurance?

In some cases, patients can submit claims to their secondary insurance to see what costs are covered. Dr. Russell Weg’s office will assist by providing you an itemized bill with all necessary details, such as CPT codes, diagnosis codes, and proof of payment for you to submit to your secondary insurance. Secondary insurance policies vary, so it’s important to understand specific plan rules. Contacting your secondary insurance carrier directly for clarification is often helpful.

Does This Change Apply to Other Insurance Plans? 

This change specifically affects Medicare-enrolled patients of Dr. Russell Weg. If you have solely private insurance, such as Oxford, United, Empire, Cigna, Aetna and Blue Cross-Blue Shield, services will continue to be billed to your insurer as they have been previously. 

What Will Medicare Cover Under The Direct Care Fee-For-Service Model?

While Dr. Russell Weg’s office will no longer be able to bill Medicare for his services, all bloodwork, out-of-office imaging and medications will still be covered in accordance with Medicare policy. 

What Will NOT Be Covered By Medicare Under The Direct Care Fee-For-Service Model?  

Out-of-pocket fees apply exclusively to the doctor’s services and any in-office procedures, such as venipuncture, EKG, or chest X-rays. These fees will be collected at the time of service and apply to both Primary Care as well as Gastroenterology and Hepatology visits.

Are Endoscopy, Colonoscopy And Capsule Endoscopy Covered Under The Direct Care Fee-For-Service Model? 

As an out-of-Medicare provider, Dr. Russell Weg’s services cannot be billed to Medicare for reimbursement. Therefore, there will be an out-of-pocket fee for Dr. Russell Weg’s expertise in completing the procedure. Procedures will continue to be performed within the privacy and convenience of our office. 

Anesthesia and pathology services will be managed by Medicare-participating providers, billed separately, and submitted to Medicare as they have been previously.  

Can I Still Submit Claims To Medicare For Reimbursement?

No. In accordance with Medicare policy, when a doctor is out of Medicare, both the doctor and the patient are prohibited from submitting claims to Medicare for reimbursement of services provided by that doctor.

Will I Have To Sign Anything Before Seeing Dr. Russell Weg?

Yes. Medicare requires patients to sign a Medicare Private Contract stating that you understand Dr. Russell Weg has opted out of Medicare and that you agree to pay for services and will not seek reimbursement from Medicare. This can be signed at the time of your appointment.

What Is The Best Type of Medicare Plan Under This Model?

The best type of Medicare plan depends on your specific needs, including consideration of out-of-pocket expenses and the level of coverage you prefer. Options include Original Medicare, Medigap plans, Medicare Advantage plans and High Deductible Medigap plans. Patients may prefer plans that have a high-deductible with lower premiums to reduce overall costs. These plans offer coverage for unexpected, high-cost medical events like surgeries or hospitalizations while avoiding redundant expenses for routine services. Consulting with your Medicare advisor can help you determine the plan that best suits your circumstances.

What Are The Fees?

We are committed to delivering the exceptional care and experience you deserve. Our fees have been carefully set to prioritize fairness and accessibility, and we are proud to be able to offer rates that are considerably lower than those in similar practices.

Think of this as an investment in your health and well-being. Much like the cost of a gym membership, personal training sessions, or a weekend getaway, this approach ensures you receive care unbound by Medicare constraints, with a devoted doctor entirely focused on your health and personalized service.

For more information, please contact us at RAWMedicare@gmail.com or call our office. 

Will There Be A Copay?

With the direct care fee-for-service model, there are no copays to see the doctor. Patients pay directly for the services they receive at the time of their appointment, simplifying the payment process and eliminating additional fees typically associated with insurance-based care.

What Forms Of Payment Do You Accept? 

Dr. Russell Weg’s office accepts cash, check, Zelle, Venmo, credit cards and Apple Pay. Full payment will be required at the time of your visit.

Can I Use My Health Savings Account (HSA)?

Yes, you can use your health savings account (HSA) to pay for the doctor’s services depending on your account rules. Please check with your account provider to ensure the doctor’s services are considered a “qualified healthcare expense.”

How Does This Differ From Concierge Care?

Concierge care involves paying an annual or monthly membership fee (a retainer) for enhanced access and services. In New York City, these fees can range from $10,000 to $50,000 annually. In contrast, the direct care fee-for-service model focuses on delivering care as needed, allowing for a more affordable and flexible option for personalized, dedicated care.

What If I Have a Medical Emergency?

If emergency services are needed, Medicare will pay for services that are considered medically necessary and fall under the coverage of Parts A and B. 

Will Dr. Arnold Weg Still Be Accepting Medicare?

For the time being, there will be no change to Dr. Arnold Weg’s practice. 

How Do I Ask Additional Questions? 

We understand this process can feel complex, but we are here to support you every step of the way. Please let us know if you have additional questions or concerns. You can visit our website at WegMedicine.com/DirectCare. You may also call our office at 212-249-3737 or you can email us regarding these changes specifically at RAWMedicare@gmail.com. Please note, this email is for questions regarding this transition only.

This Is Not For Me. What Should I Do For My Medical Care? 

This change is meant to enhance the service and care you receive unbound by Medicare restrictions. While it saddens us to see you go, we are thankful for the privilege to be able to participate in your care. Please contact your insurance company to find a provider that is right for you and remember these changes do not take effect until April 1, 2025. Our office will provide a one-time master copy of your records free-of-charge to either you or your new provider upon request and we will be happy to communicate with them should the need arise.