New and return office visits.
Periodic physicals, including sports, school and employment (Not FAA).
Routine office supplies including casting material and in office injectables (such as Xylocaine, corticosteroids, penicillin) not excluded below.
PAP smear and ONE follow-up PAP smear if indicated, annually as clinically necessary. This is the ONLY exception to the "purchased services" exclusion below. NOTE: PAP smear processing is no longer included (a new Federal law prohibits HFM including pathology fees in our "package".
ECG, interpreted by the Provider.
Minor surgical and orthopedic procedures (including warts, abscesses, lacerations, non-displaced fractures).
In office laboratory procedures (urinalysis, glucose, microscopy studies, pregnancy testing), and additional laboratory procedures as listed to the right, if elected for an additional monthly fee.
Provide that level of service and accessibility (or better) provided to all other patients in the practice of the Provider to those with DCMD (with exception to those services in the "Exclusions" listed below).
Provide same day or next regularly scheduled day access to ill Enrollees, and appointments within 7 regularly scheduled working days for routine visits.
Provide "coverage" by other similarly qualified individuals for 24/7 telephone coverage and scheduled office visits for ill Enrollees at those times Provider is not personally available. Typically, such coverage is provided by other members of a group practice, or another practice agreeing to honor the DCMD agreement.
Directly compensate "covering" physicians for services rendered to Enrollees within Provider's panel or do so through the mechanism provided between participating Providers by DCMD.
"Take home" medications.
Specialized medications such as cancer chemotherapeutics, joint synovial fluid enhancers, injectable antibiotics (other than penicillin).
Durable medical equipment (i.e. things that can be re-used, such as braces, crutches, or an ACE bandage).
Specialized surgeries (e.g. vasectomy, dilatation and curettage, colposcopy, endoscopy of any orifice).
Other Specialized services:
Osteopathic Manipulation - "OMT" (a specialized service not part of usual primary care.)
Visits solely for weight loss (a specialized service - if however, part of the management of medical illness like high blood pressure or diabetes - it will be covered).
Radiologist, Pathologist, or Cardiologist consultation (i.e. if a questionable x-ray, suspicious skin lesion, or difficult ECG requires the assessment of consultants in those fields). Typically, those consultants will bill the enrollee directly.
"Send -out" laboratory work (PAP smear processing is no longer covered--a new Federal law prohibits HFM including pathology fees in our "package"). Typically the receiving laboratory will bill the enrollee directly.
Services provided by others, may be (but are not required) charged directly by the Provider to Enrollee as mutually convenient, provided the charge is less than or equal to that which would have been charged to the Enrollee if billed directly by the outside service provider (e.g. a laboratory or consulting radiologist, or pathologist. These may include:
Home Sleep Study (an outside vendor)
Carotid Intimal Thickness Evaluation (we bring in an outside vendor)
Laboratory cultures (an outside vendor)
Services provided by a Hospital.
Services rendered in the Emergency Room, or an Urgent Care Center EVEN if directed there by your Provider.
AFter hours direct care by your Provider. The providers DCMD represents are encouraged when possible to meet patients in their office outside of published hours where the situation seems amenable to that level of intervention. The Enrollee should request an estimate of the anticipated fee and expected method of payment when such an appointment is agreed to. Typically, that fee will not be les that $80.00 to be paid at the time of service. If a Provider routinely provides care to patient on certain evening or weekend hours - these published times are not subject to an after hours charge.