- While most insurance plans cover primary care office visits and other services, patients often have difficulty in obtaining timely appointments with their doctor and rarely have adequate time for their concerns to be fully heard and addressed. Despite their best intentions, physicians are frequently left feeling rushed and unable to fully address wellness and preventive health approaches.

- Criterion Medical’s membership model provides a level of personal service not generally found in a traditional primary care medical practice, including direct access to our providers, office visits of more than 15 minutes,  and true coordination of your care with specialists and other physicians handled personally by Criterion Medical providers

- This membership model is NOT an insurance plan, and you will need to keep your existing insurance to pay for specialist physician services, laboratory tests, imaging, and other diagnostic services not covered under the membership fee, prescription drugs, and hospitalizations

- Because the membership pays for some services that are not covered by insurance, your insurance plan might not apply the membership fee towards your deductible.  Each insurance plan may approach this issue differently, so if you have more specific questions, you should contact your insurance company representative. Criterion can provide you with a fee ticket for your annual physical examination which you may be able to submit to your private insurance to see out-of-network reimbursement, BUT NOT MEDICARE, TRICARE, OR ANY HMO. (Again, different insurers approach this differently, so check your plan)

- Yes. However, because Criterion Medical has opted out of the Medicare program, Medicare will not cover any portion of the membership fee or any services provided by Criterion Medical that are charged separately outside the membership fee. Criterion Medical will not submit any claims to Medicare and you may not submit any claims to Medicare for payment for any services provided by Criterion Medical. Criterion Medical may continue to write prescriptions and orders for lab, x-ray, and other services needed outside of the Practice, and your Medicare coverage will continue to cover services from other physicians, hospitals, and labs. Participation in Criterion Medical will not affect your Medicare coverage for these other services in any way

- Yes. However, it is important to understand that Criterion Medical  does not participate in any HMOs. If your HMO requires prior authorization from your primary care physician for referrals to specialists, lab tests, and other such services, Criterion Medical will not be able to perform that role. Also, Criterion Medical will not submit any claims to your HMO and you may not submit claims to your HMO for payment of any services provided by Criteiron Medical.

- It depends. TRICARE For Life (TRICARE’s Medicare “wrap-around” product) specifically permits Medicare beneficiaries to privately contract with opted-out physicians; however, due to TRICARE For Life billing limitations, Dr. Sirdar will not submit any claims to TRICARE For Life and you may not submit claims to TRICARE For Life for payment for any services provided by Dr. Sirdar. If you are covered by any of the other TRICARE plans (including but not limited to: TRICARE Prime, TRICARE Prime Remote, TRICARE Standard, TRICARE Extra, TRICARE Reserve Select, TRICARE Retired Reserve, and US Family Health Plan), Dr. Sirdar will not be able to provide services to you under her new membership practice model 

- In many cases, you may be able to use such funds to pay for all or a portion of the membership fee, but policies differ from plan to plan, so please check with your plan administrator.