Frequently Asked Questions
What is a membership practice?
The “membership practice” model is one in which each patient who is a member of the practice pays an Annual Fee that covers some of the Internal Medicine care received in-office as well as enhanced services not normally available in a traditional medical practice, such as extended office hours, direct access to the physician by email, same or next day sick appointments, unhurried office visits, short in-office wait times, and coordination with specialists. It also includes coordination with hospital physicians, should you be hospitalized. This new approach is really a return to old-fashioned care. It is a smaller, more intimate practice that allows you to have a personal relationship with your physician. The goal is to provide care that is more responsive, thorough, and individualized. Dr. DiFresco provides services that place a premium on time and relationship-based medical care. To provide this level of individualized medical attention, we see fewer patients per day and we charge a membership fee instead of accepting insurance.
Does Dr. DiFresco offer a membership plan?
Yes. Dr. DiFresco offers two membership options: Foxhall Internists Prime and Foxhall Insternists Prime +5.
What is the fee for Foxhall Internists Prime?
Dr. DiFresco’s Annual Fee for Foxhall Internists Prime is $1,800 per patient, payable by credit card on an annual basis. As long as you stay with the practice, you will renew this payment every 12 months. For example, if you enroll in October 2022, you will renew your membership in October 2023. Please understand that you need to pay the annual fee before we are able to schedule an appointment
What does the Foxhall Internists Prime Annual Fee cover?
- Extended, comprehensive annual physical examination
- Comprehensive lab testing associated with the Annual Physical
- Flu shot and tetanus shot when they are due
- Access to same day/next day appointments
- Patient portal through which you can contact your doctor. The portal also gives you
access to labs and reports in our EMR
- Access to nighttime and weekend on-call physicians. This call will be covered by several
doctors in the Foxhall practice.
- Extensive review of outside medical records
- Coordination of care with specialists
- Your dependents (< 30 years of age) may be seen on a fee-for-service basis
What is the fee for Foxhall Internists Prime +5 and how does it differ from Foxhall Internists Prime?
Dr. DiFresco’s Annual Fee for Foxhall Internists Prime +5 is $2400 per patient, payable by credit card on an annual basis. As long as you stay with the practice, you will renew this payment every 12 months. For example, if you enroll in October 2022, you will renew your membership in October 2023. Please understand that you need to pay the annual fee before we are able to schedule an appointment.
- This plan covers all of the services listed above in Foxhall Prime plus 5 additional visits
(this includes in-person and telemedicine visits).
What other expenses will I incur?
- Labs: Please note – Foxhall Internists has its own in-house lab. If you come for lab work
outside of the Physical Exam, you will be charged for labs. Payment for these labs is
expected at the time of service.
- Vaccinations: (other than tetanus and flu vaccine)
- Additional visits: (in-office or telemedicine/video visits) visits outside of the physical exam (or beyond the 5 visits in the Foxhall Internists Prime +5 plan)
- Phone calls: Extended phone calls or calls that address a new or complex problem. It is up to the discretion of the doctor if this is designated a telemedicine visit and will incur a fee
Do I have to pay a co-pay?
There are no co-pays for services covered under the Annual Fee.
I already have good health insurance – why should I pay extra to join this practice?
The membership model provides a level of personal service not generally found in a traditional primary care medical practice, including extended hours, direct access to your physician email, comprehensive office visits, and true coordination of your care with specialists and other physicians handled personally by your physician.
Do I need to keep my existing health insurance?
Foxhall Prime is NOT an insurance plan, and you will need to keep your existing health insurance to cover specialist physician services, lab tests, x-ray and other diagnostic services, prescription drugs, and hospitalizations.
Can the annual fee be submitted to my insurance company for reimbursement?
Yes, at the time of your annual physical exam and any office visits, Foxhall will provide you with
paperwork that reflects services you received that day as well as proof of payment. You may
submit directly to your insurance for reimbursement. Each insurance plan will approach this
issue differently, so if you have more specific questions, you should contact your insurance
company representative. This does not apply to Medicare or HMO plans. In addition, different
insurers approach this differently, so check with your health plan.
How do I pay?
We prefer to invoice our patients through a system called HINT Health. If you have difficulty using the HINT Health system, please call or email us and we will process your credit card over the phone.
I’m covered by Medicare. Can I still come see Dr. DiFresco?
Yes, however, because Dr. DiFresco has opted out of the Medicare program, Medicare will not cover any portion of the Annual Fee or any services provided that are charged separately outside the Annual Fee. We will not submit any claims to Medicare and you may not submit claims to Medicare for payment for any services provided by our office. Dr. DiFresco will continue to write prescriptions and orders for x-rays, and other services needed outside of her practice. Your Medicare coverage will continue to cover all other physician visits, hospital bills and procedures done outside of our office. Participation in Foxhall Prime or Foxhall Prime +5 will not affect your Medicare coverage for these other services in any way.
*Please note, Foxhall Internists Prime does have some physicians who participate in Medicare, so the Foxhall website references arrangements specific to Medicare. Dr. DiFresco is entirely opted out of Medicare, so these arrangements do not apply to her practice.
I’m covered by an HMO. Can I still join the practice?
Yes; however, it’s important to understand that the doctors do not participate in any HMOs. If your HMO requires prior authorization from your primary care physician for referrals and labs, we will not be able to perform that role. Also, we will not submit any claims to your HMO and you may not submit claims to your HMO for payment for any services provided by Dr. DiFresco.
I have a Health Spending Account, Flexible Spending Plan, or a Medical Savings Plan through work. Can I use that to pay for the Annual Fee?
In many cases, you may be able to use such funds to pay for all or a portion of the Annual Fee, but policies differ from plan to plan, so please check with your plan administrator. By using pre-tax dollars designated for medical expenditures, you may be able to reduce your out-of-pocket expenses.
Can I use my deductible for the annual fee?
Because the Annual Fee pays for some services that are not covered by insurance, your insurance plan may or may not apply the annual fee towards your deductible. Different insurers approach this differently, so check with your health plan.
What if I need to be hospitalized?
You may be hospitalized at the hospital of your choice. Although the hospitalist service will be
the attending physician of record, Dr. DiFresco will coordinate care with the hospitalist as your personal physician. She currently has courtesy privileges at Johns Hopkins/Suburban Hospital, and she anticipates securing privileges at Sibley Hospital and Georgetown Hospital in the next year. In addition, because of her affiliation with Suburban, she has access to the Hopkins EPIC EMR and can view those reports. Dr. DiFresco sees it as part of her job to coordinate with your inpatient team and provide input into your care as appropriate.
What do I do if I need to see a specialist?
Dr. DiFresco will coordinate your appointment with the appropriate specialist(s) to best address your particular medical condition. She will closely monitor your progress while you are under the specialist’s care, and she will do her best to find specialists who are in-network with your insurance plan.
What if I am sick or need medication refills and Dr. DiFresco is on vacation?
As they did while practicing together for 10 years at Bethesda Physicians, Drs. DiFresco and Fine will typically see their own patients. However, if one of them is away, the other will be happy to refill medications or take care of you when you are sick.
How can I reach a doctor after hours and on weekends?
If you need to reach us after the office is closed to discuss an urgent matter, you may also use the main phone number 202-362-4467, and you will be connected to our answering service and assisted by the on-call Foxhall Internists physician. If for some reason you are not directed automatically to the answering service, or you are not able to get through to our office during normal business hours, please contact our answering service directly by calling 301-446-2541. For emergencies, please call 911.
You will not be charged for after hours phone calls, however, if follow up is needed, you will be asked to make an appointment with your doctor.
How do I join?
You may start the process by calling Foxhall Internists at 202-362-4467 or email Dr. DiFresco’s secretary LaToya Powell (email@example.com) to request an enrollment package. You will need to sign a Physician-Patient Agreement and submit payment of the Annual Fee in order to become a member. Patients will be accepted in the order in which they join, and once Dr. DiFresco reaches capacity, she will not accept any additional patients until an existing spot opens up.