Membership

Fort Myers Family Medicine Self-Pay Solution Membership

As our National Healthcare Debacle worsens, 50 million deserving Americans are without affordable basic healthcare. For 30% of Americans who are under Medicare age, access to preventative health services has become a distant luxury, and treatment of minor urgent health problems by inappropriate facilities can precipitate severe financial hardship.

It is the position of Fort Myers Family Medicine that the American Healthcare System is so misaligned in priority of incentives, so inefficient in delivery, and politically compromised by special interest groups that any immediate, significant healthcare reform is a remote possibility.

That is why Fort Myers Family Medicine is offering our Self-Pay Solution Membership: to help make basic primary healthcare an accessible reality.

This is a membership, not insurance. We strongly suggest that everyone should at least have a hospitalization insurance policy. They are much less expensive and more affordable than "full-coverage" insurance policies

If you wish to become a member print the application. Read and sign the application. Return it to the office. Office staff will take the initial payment and execute auto debit from your credit card and receive your membership card.

What's Included

All Preventative Service Visits

15 Visits per year with $10.00 co-pay. (if more than 15 are needed, the patient will be charged according to the Self-Pay fee schedule)

$75/month Membership Fee or $200 quartly fee ($25 discount)

Statement Patient Bill of Rights

Access to Your Personal Health Information. Generally, you have the right to access, inspect, and/or copy personal health information that we maintain about you. Unless you are currently a patient in our facility during a scheduled appointment with a clinician, requests for access must be made in writing and be signed by you or your representative. We will charge you for a copy of your medical records in accordance with a schedule of fees established by applicable state law. You may obtain an access request form from the doctor's office. Amendments to Your Personal Health Information. You have the right to request that personal health information that we maintain about you be amended or corrected. We are not obligated to make all requested amendments but will give each request careful consideration. All amendment requests, in order to be considered by us, must be in writing, signed by you or your representative, and must state the reasons for the amendment/correction request. If an amendment or correction you request is made by us, we may also notify others who work with us and have copies of the uncorrected record if we believe that such notification is necessary. Please note that even if we accept your request, we may not delete any information already documented in your medical record. You may obtain an amendment request form from the doctor's office you visited.

Accounting for Disclosures of Your Personal Health Information. You have the right to receive an accounting of certain disclosures made by us of your personal health information except for disclosures made for purposes of treatment, payment, and healthcare operations or for certain other limited exceptions. Requests must be made in writing and signed by you or your representative. Restrictions on Use and Disclosure of Your Personal Health Information. You have the right to request restrictions on certain of our uses and disclosures of your personal health information for treatment, payment, or health care operations. For example, you may request that we do not share your health information with a certain family member. A restriction request form can be obtained from the doctor's office. We are not required to agree to your restriction request but will attempt to accommodate reasonable requests when appropriate and we retain the right to terminate an agreedto restriction if we believe such termination is appropriate. In the event we have terminated an agreed upon restriction, we will notify you of such termination.

Confidential Communications. You have the right to request communications regarding your personal health information from us by alternative means or at alternative locations and we will accommodate reasonable requests by you. You must request such confidential communication in writing to each department to which you would like the request to apply.

Paper Copy of Notice. As a patient you retain the right to obtain a paper copy of this Notice of Privacy Practices, even if you have requested such copy by e-mail or other electronic means.

ADDITIONAL INFORMATION

Complaints. If you believe your privacy rights have been violated, you may file a complaint in writing with the doctor's office. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services in Washington D.C. All complaints must be made in writing and in no way will affect the quality of care you receive from us.