Do I need medical insurance if I join Seattle Medical Associates?

We recommend that you carry health insurance to provide coverage for services not performed in our office. Your annual fee will allow Seattle Medical Associates (SMA) to perform medical, laboratory, or x-ray services in our office at no additional cost. Outside of our office, you will still be responsible for charges incurred, such as hospital bills, prescriptions, consultations with specialists, CAT or MRI scans, as well as tests performed at other laboratories. We suggest that you discuss your coverage needs with your insurance provider. You may require only major medical coverage or be able to buy lower cost, higher deductible insurance than you currently have.

I am in a managed care plan. Can I still join SMA?

Yes. Your annual fee ensures you access to care from SMA regardless of your insurance plan. However, you should know that your managed care company, or your health maintenance organization (HMO), may refuse to pay for any outside services or prescriptions that are not ordered by one of their physicians.

What kind of insurance will work best with SMA?

Traditional fee-for-service plans, even if part of a preferred provider organization (PPO), will allow us to coordinate your care best. They also permit you to make appointments with specialists yourself, should you desire. Unlike managed care plans and some point-of-service plans, they do not require that your primary care physician be from their network.

If I go to an emergency room on the weekend, or see another doctor, will SMA pay my bill?

No. Your annual fee ensures you access to care at our clinic or from us at Swedish Medical Center (should you be hospitalized). You are responsible for any charges incurred for services not provided by SMA.

Do I still have to pay your annual fee if I am on Medicare?

Yes, you will be required to pay our annual fee; we are not Medicare providers. However, like any other insurance policy, Medicare should still pay for medical services obtained outside our office according to the terms of your Medicare contract.

My company offers me a Flex (Section 125) Plan or a Health Savings Account to pay for expected medical expenses with pre-tax dollars. May I claim my SMA annual fee on these plans?

In some cases, yes. We strongly encourage you to talk with your tax advisor, employer and Human Resources Department about this option prior to setting aside your funds. IRS rules are very strict and some companies require documentation we cannot provide.

Can I join SMA at any time?

We believe that in order to provide the individual, high-quality medical care that we have promised you, we need to limit the number of patients enrolled with SMA. Those who are interested may contact the practice for more information about new patient applications.

Will I receive a discount if I don't have my annual physical exam or use all of your services?

No. Your annual fee covers our availability for complete supervision of your medical care. We encourage each of our patients to see us on a regular basis. Preventive care is the best foundation for an excellent quality of life.

If I become ill and require extensive medical services, will my bill increase?

Never. Your financial relationship with SMA is not influenced by health or illness.

Since I need to keep my insurance, will there be any problem with reimbursement for outside tests ordered through SMA?

No, this has not been a problem for our patients. Most of you are in medical plans in which out of network providers are allowed to order tests and provide hospital care. On the other hand, a few of you are in managed care plans that almost certainly will refuse to pay for any tests we order. You may be required to get permission for these tests from your assigned “gatekeeper”. For this reason, we recommend you re-evaluate the kind of insurance you have. However, regardless of your coverage, we will make every effort to get you the best care your insurance will allow.

Is the cost of prescriptions covered or discounted through my annual fee to SMA?

Your annual fee does not include the cost of prescriptions, but we always attempt to provide you with free samples for an acute condition, if they are available.

If I need to be hospitalized, where will I go?

We are proud to be affiliated with both Virginia Mason and Swedish Medical Center, each recognized locally and nationally for superb quality care and service.

Can I still see my gynecologist?

Yes. We are well trained and extremely experienced in routine, outpatient gynecological care, but we recognize that many women prefer to see a gynecologist separately. As always, we will support and facilitate whatever decision works best for you.

If I get married or have/adopt a child, can I extend coverage to my new family members?

Children over 14, spouses and partners can be added as long as there is space available in our practice.

What happens if I move after I join?

We have patients who live all over the world, but if you must move and transfer your care, we will assist you with finding a new physician. Your medical records will be sent promptly upon your release of information. The balance of your yearly fee will be prorated and refunded.