Services & Pricing

Direct Primary Care membership includes routine visits, care and services between visits including phone, telehealth, or patient portal communication when appropriate.  Members are eligible for discounted medications and laboratory studies.  Cold River Health does not bill insurance other than Medicare Part B (Original Medicare).  Patients with Medicare do not pay a monthly membership fee.

Membership pricing per month:

• First household member:   $85.00

• Additional household members: $60.00

• Family pricing for 2 adults and 2 children under age 21 is $175/month, additional children $25/month

Household members will be billed together.  Students of MSAD72 are eligible for discounted membership.  

Additional information:

An initial enrollment fee of $100/patient with a maximum of $200/family for members enrolling at the same time is required to review records.  The enrollment fee is waived for members paying for a year of membership at the time of enrollment.  Cold River Health reserves the right to charge this fee upon re-enrollment for patients who have cancelled their membership or allowed their membership to lapse.  Re-enrollment is at the discretion of Cold River Health.

Home visits within the state of Maine and within a 45 minute radius of Cold River Health may be available at the discretion of Dr. McElroy.  Additional fees may apply.

Urgent care access after hours and on weekends is not guaranteed but may be available for an additional fee.

Women's health throughout the lifespan:

• Well women exams including routine pap smears.

• Reproductive health counseling for adolescents through adults.  Dr. McElroy performs IUD insertions and places implantable contraceptive devices under the skin for those desiring reliable contraception and/or management of menstrual cycles.

• Evaluation of abnormal pap smears or bleeding patterns with colposcopy and/or endometrial biopsy.

• Support through menopause, evaluation for osteoporosis, and close attention and sensitivity to the unique challenges and stresses that women face throughout the lifespan are hallmarks of the care you will receive at Cold River Health.

Women who are not in need of ongoing medical care through membership but who are due for a routine gynecologic exam may schedule a one-time appointment for $200.00 with additional costs for lab studies or pathology.  This includes follow-up care required during this one-month membership.

Providing exceptional care for newborns to adolescents for both check-ups and sick visits.

• Well child checks, school, camp, and sports physicals are included for Direct Primary Care members.

• Routine immunizations are provided for residents of Maine through the Maine Immunization Program.

• Management of acute illness and ongoing medical issues such as asthma, attention deficit disorder, and mood concerns.

• Newborn care and Fourth Trimester support for member families including breastfeeding and postpartum support

Membership pricing per month:

• First household member: $85.00

• Additional household members: $60.00

• Students of MSAD72 school district receive a discounted membership rate of $50.00.  Additional sliding scale fees are based on eligibility for free and reduced lunch programs.  

School and sports physicals are available to non-members based on availability.  Please contact the office for more information.

Lifestyle Medicine can benefit everyone, no matter your age or health conditions!

Lifestyle Medicine consultation is available to those who wish to supplement their traditional healthcare by focusing on the elements of lifestyle that impact and can modify health conditions such as diabetes, insomnia, depression, elevated blood pressure and cholesterol, or dependence on tobacco or other substances, and is incorporated into routine preventive and chronic condition-focused appointments.

Primary care office-based procedures include:

• Skin laceration repair

• Biopsies of skin lesions, removal of skin tags and small cysts, and wart treatments

• Gynecologic procedures including routine pap smears, colposcopy for abnormal pap smears, endometrial biopsies, and placement of long-acting reversible birth control such as IUDs and implantable contraception

• Trigger point and joint injections

• EKG and interpretation

Cost:

Most procedures are included in the membership fee.  Patients will be notified in advance if additional costs will be incurred.  Additional fees for pathology services in the case of biopsies will apply at the rate determined by the pathology lab or as covered by insurance.  After-hours urgent procedures are subject to an additional fee.

Urgent care appointments during regular office hours are included for Direct Primary Care members and can typically be scheduled within 1 business day.

Urgent or single problem-focused visits may be provided to non-members based on availability at the cost of $200.00.  The cost of the visit includes follow-up on tests ordered by phone or telehealth.  Additional follow-up for ongoing or newly identified issues can only be done at another in-person visit.  This service is intended for patients temporarily visiting the area who are in need of care or those who cannot access their primary care physician due to distance or other barriers.  Availability is not guaranteed for non-members.  After-hours fees and supply charges may apply depending on the nature of the appointment. 

Cold River Health is enrolled with Medicare Part B, or Original Medicare.

Medicare Part B, Original Medicare and Supplemental plans:

Patients with Medicare Part B may enroll as patients at Cold River Health and do not pay a monthly membership fee.  Cold River Health bills Medicare directly for services rendered.  Supplemental Medicare plans are all accepted and do not differential between in- and out-of-network physicians.  

Medicare Advantage Plans: 

Cold River Health does not participate as in-network with Medicare Advantage plans.  Please contact your insurance company if you have a Medicare Advantage plan to find out if you will be responsible for out-of-network charges or if your plan will limit you to only seeing in-network facilities and physicians.  As a small, independent practice, Cold River Health cannot be responsible for knowing the rules and limitations of insurances that we are not participating in.  If your insurance card has the word "Advantage" on it, you are enrolled in a Medicare Advantage plan and are required to use this.  By enrolling in a Medicare Advantage plan, you are not able to use regular Medicare Part B benefits.  

As a general guide, if your card has "HMO" anywhere on it, you will not be able to be seen at Cold River Health because your insurance plan has chosen which doctors you can see and Dr. McElroy does not participate in these plans due to the additional paperwork burdens that they create without evidence that they provide superior care.  One exception at this time is Martins Point Generations Advantage HMO-POS plans which allow patients to receive care by Dr. McElroy and typically require the patient to pay the "out-of-network specialist" co-payment.  

If your card says "PPO" on it, you most likely can see Dr. McElroy but may have to pay a higher copayment and have a higher deductible for out-of-network services.  Medicare Advantage PPOs may still limit your ability to receive certain services.  Due to non-payment by these plans, telehealth services may not be available to patients with Medicare Advantage plans.

Dr. McElroy strongly encourages patients to sign up with Original Medicare with a supplemental plan and not a Medicare Advantage Plan unless this is the only option available to them through retirement benefits.  Medicare Advantage plans create a significant administrative burden through their billing practices and the requirement for prior authorizations for medications, studies, and referrals.  Cold River Health reserves the right to charge a fee for obtaining prior authorizations that is paid by the patient.  

Services:

All Medicare Part B beneficiaries are entitled to an Annual Wellness Visit, which is a preventive health visit focused on the screenings and services covered by Medicare and that the beneficiary is entitled to.  Medicare has guidelines about what must be covered during the Annual Wellness visit.  For more information about what an Annual Wellness visit is and isn't, please visit www.medicare.gov.

Patients with Medicare who have chronic medical conditions can benefit from participating in Chronic Care Management, which allows us to monitor your health and manage your needs between appointments.

The availability of telehealth visits and management of medical conditions outside of scheduled appointments, such as via portal messaging, is subject to Medicare rules and regulations and billing.