FREQUENTLY ASKED QUESTIONS
Common questions about Criterion Medical and our care.
Direct Primary Care (DPC) Membership
What is a Direct Primary Care (DPC) model of Healthcare delivery?
- Direct Primary Care (DPC) model of healthcare delivery is one in which comprehensive primary care services are provided without insurance billing.
- This model allows for more personalized, affordable, and transparent care. Patients pay a flat fee for a comprehensive range of primary care services, including routine check-ups and preventive care.
- Benefits of membership include extended consultations, enhanced access and direct communication (phone/email/text).
What is a “membership practice”?
- The DPC membership practice offered by Criterion Medical is one in which each patient seen at Criterion Medical pays a flat fee that covers most of the primary care and/or substance use disorder care received in-office.
- This model provides enhanced services not normally available in a traditional medical practice, like direct access to physicians, the patient portal, and encrypted HIPAA compliant text messaging and video calls; same day or next-day sick appointments, unhurried office visits, short in-office wait time. This model is really not new, rather, it is a return to old-fashioned medical care. The goal is to provide care that is more responsive, thorough and individualized.
- This model works really well with high deductible health insurance plans, FS/HSA, uninsured and/or underinsured.
What if I need to be hospitalized?
- No physician at Criterion has medical staff privileges at any of the local hospitals in the Hudson Valley/Orange County. The hospitalist service will be the attending physician of record, but Criterion physicians will coordinate care with the hospitalist as your personal physician.
What if I need to see a specialist?
- Criterion Medical physicians will coordinate your appointment with the appropriate specialist(s) to best address your particular medical condition. Your progress will be closely monitored while you are under the specialist’s care.
What if I need psychiatric medications or opioids for pain relief?
- Criterion Medical physicians do not prescribe or manage psychiatric medications but will assist you in finding an appropriately qualified psychiatrist to manage any medications you may need.
- Criterion Medical physicians do not prescribe opioids for chronic pain. Controlled medications are only prescribed in the setting of substance use disorder that necessitates prescription.
How do I reach Criterion Medical Physicians after hours/weekends/vacation?
- If you have a serious or life-threatening emergency, you will need to go to your nearest Hospital Emergency Department as Criterion Medical does not provide that type of emergency care. For routine matters, you can contact our office during normal office hours. For anything that requires priority attention or for any non-emergency but non-routine matters, you can call the Criterion Medical cell phone, and you will get a response as soon as possible. (See the attached “Patient Communication Guidelines” for more information.)
How old are your patients?
- Criterion Medical will see patients 18 years or older.
- Per New York State regulations, minors seeking substance use disorder/ addiction treatment can be seen without a parent or guardian present.
What is the office schedule?
- We are currently seeing patients in person and via telemedicine Monday-Friday 4:30pm to 7:30pm and Saturdays 9 am to 3pm
What do I do if I can’t make my appointment?
- At Criterion Medical, we require at least 24 hours notice to cancel or reschedule. Call or text use prior to 24 hours so that our office can reschedule you right away.
- If you miss your scheduled appointment, we will apply a fee of $50. If you are running late let us know- we are happy to reschedule your appointment.
- Criterion medical reserves the right to cancel membership of members who habitually miss appointments.
Insurance Information
I already have good health insurance- why should I pay extra to join this practice?
- While most insurance plans cover primary care office visits and other services, patients often have difficulty obtaining timely appointments 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 physicians.
Is this an insurance plan? Do I need to keep my existing health insurance?
- 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
Can the membership fee be applied towards my insurance plan deductible?
- 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)
I am covered by Medicare. Can I still join Criterion Medical?
- 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
I’m covered by an HMO. can I still join Criterion Medical?
- 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.
I’m covered by TRICARE or am an active-duty service member. Can I still join Criterion 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, Criterion Medical physicians 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 Criterion Medical physicians. 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), Criterion Medical physicians will not be able to provide services to you under her new membership practice model
I have a Health Spending Account, Flexible Spending Plan, or a Medical Savings Plan through work. Can I use that to pay the membership fee?
- 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.
Cost and payment
How much is the one-time registration fee?
- The one-time registration fee is payable when you initially join the practice and is not refundable should you leave the practice at any time
How much is the Membership Fee and what payment options are available?
- All fee payments are payable by credit card and you must keep a valid credit card on file with the practice at all times
What does the membership cover?
- Attached is a detailed description of all services covered by the membership fee. See Attachment here.
Is the fee refundable if I move or simply decide this practice model is not right for me?
- Yes, the Membership Fee covers services available to you while you are in the Practice and you can cancel anytime
Do I have a copay?
- There are no co-pays for services covered under the flat fee. For any visits or other services beyond those covered under the membership fee, the practice will collect a per-service fee as indicated on the attached description of services.
Becoming a member
How do I join?
- You may start the process by going to the website www.criterionmedicalpllc.com and join the Enrollment list. You will then be invited to self-schedule a meet and greet on the calendar by sending our office an email at [email protected] to request an enrollment package. If accepted into the Practice, you will need to sign a Patient Agreement and submit payment of the initial registration fee in order to become a member of the Practice. Patients will be accepted in the order in which they join, and once the Practice reaches 150 members, no additional patients will be accepted into the Practice until a spot opens up.
What is the Enrollment List?
- We are maintaining a Enrollment List of patients who want to be guaranteed the opportunity to enroll as a member. Because we must keep our patients to a limited number and ensure our premium patient-focused care, we encourage you to sign up today with no fees or obligations
When can I join?
- Our enrollment period has begun and we started accepting payments and scheduling patient appointments. We expect to reach capacity very quickly, so we strongly encourage you to join the Enrollment List so you are guaranteed the opportunity to enroll.
Can I meet the physicians at Criterion Medical before I commit?
- We would love to schedule a brief 15 min introductory visit with our physicians so we can get to know each other and make sure our practice is the right fit for your healthcare needs. This informal meet-and-greet gives us both the opportunity to ensure we can provide the personalized care you are looking for
When will the Criterion Medical office open?
- We are scheduling patients from 9/1/2026 onwards.
Is it possible to be seen at Criterion Medical without signing up for a membership?
- We offer a limited number of non-member appointments for acute or urgent concerns, including pre-operative evaluations, subject to availability. To ensure we provide the highest quality care and proper follow-up for our patients, we generally cannot accommodate one-time visits for routine wellness exams, mental health needs, ongoing chronic conditions, or second opinions.
- Non-member visits are $300 per appointment (tests and procedures not included) and must be paid at the time of service.
- Please note: Non-members do not have direct access to Criterion Medical Physicians outside their scheduled appointment.
I have a few more questions. What should I do?
- You can contact us at our email at [email protected] or call Criterion Medical at (845)-595-4913.
FREQUENTLY ASKED QUESTIONS
Common questions about Criterion Medical
and our care.
Direct Primary Care (DPC) Membership
What is a Direct Primary Care (DPC) model of Healthcare delivery?
- Direct Primary Care (DPC) model of healthcare delivery is one in which comprehensive primary care services are provided without insurance billing.
- This model allows for more personalized, affordable, and transparent care. Patients pay a flat fee for a comprehensive range of primary care services, including routine check-ups and preventive care.
- Benefits of membership include extended consultations, enhanced access and direct communication (phone/email/text).
What is a “membership practice”?
- The DPC membership practice offered by Criterion Medical is one in which each patient seen at Criterion Medical pays a flat fee that covers most of the primary care and/or substance use disorder care received in-office.
- This model provides enhanced services not normally available in a traditional medical practice, like direct access to physicians, the patient portal, and encrypted HIPAA compliant text messaging and video calls; same day or next-day sick appointments, unhurried office visits, short in-office wait time. This model is really not new, rather, it is a return to old-fashioned medical care. The goal is to provide care that is more responsive, thorough and individualized.
- This model works really well with high deductible health insurance plans, FS/HSA, uninsured and/or underinsured.
What if I need to be hospitalized?
- No physician at Criterion has medical staff privileges at any of the local hospitals in the Hudson Valley/Orange County. The hospitalist service will be the attending physician of record, but Criterion physicians will coordinate care with the hospitalist as your personal physician.
What if I need to see a specialist?
- Criterion Medical physicians will coordinate your appointment with the appropriate specialist(s) to best address your particular medical condition. Your progress will be closely monitored while you are under the specialist’s care.
What if I need psychiatric medications or opioids for pain relief?
- Criterion Medical physicians do not prescribe or manage psychiatric medications but will assist you in finding an appropriately qualified psychiatrist to manage any medications you may need.
- Criterion Medical physicians do not prescribe opioids for chronic pain. Controlled medications are only prescribed in the setting of substance use disorder that necessitates prescription.
How do I reach Criterion Medical Physicians after hours/weekends/vacation?
- If you have a serious or life-threatening emergency, you will need to go to your nearest Hospital Emergency Department as Criterion Medical does not provide that type of emergency care. For routine matters, you can contact our office during normal office hours. For anything that requires priority attention or for any non-emergency but non-routine matters, you can call the Criterion Medical cell phone, and you will get a response as soon as possible. (See the attached “Patient Communication Guidelines” for more information.)
How old are your patients?
- Criterion Medical will see patients 18 years or older.
- Per New York State regulations, minors seeking substance use disorder/ addiction treatment can be seen without a parent or guardian present.
What is the office schedule?
- We are currently seeing patients in person and via telemedicine Monday-Friday 4:30pm to 7:30pm and Saturdays 9 am to 3pm
What do I do if I can’t make my appointment?
- At Criterion Medical, we require at least 24 hours notice to cancel or reschedule. Call or text use prior to 24 hours so that our office can reschedule you right away.
- If you miss your scheduled appointment, we will apply a fee of $50. If you are running late let us know- we are happy to reschedule your appointment.
- Criterion medical reserves the right to cancel membership of members who habitually miss appointments.
Insurance Information
I already have good health insurance- why should I pay extra to join this practice?
- While most insurance plans cover primary care office visits and other services, patients often have difficulty obtaining timely appointments 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 physicians.
Is this an insurance plan? Do I need to keep my existing health insurance?
- 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
Can the membership fee be applied towards my insurance plan deductible?
- 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)
I am covered by Medicare. Can I still join Criterion Medical?
- 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
I’m covered by an HMO. can I still join Criterion Medical?
- 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.
I’m covered by TRICARE or am an active-duty service member. Can I still join Criterion 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, Criterion Medical physicians 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 Criterion Medical physicians. 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), Criterion Medical physicians will not be able to provide services to you under her new membership practice model
I have a Health Spending Account, Flexible Spending Plan, or a Medical Savings Plan through work. Can I use that to pay the membership fee?
- 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.
Cost and payment
How much is the one-time registration fee?
- The one-time registration fee is payable when you initially join the practice and is not refundable should you leave the practice at any time
How much is the Membership Fee and what payment options are available?
- All fee payments are payable by credit card and you must keep a valid credit card on file with the practice at all times
What does the membership cover?
- Attached is a detailed description of all services covered by the membership fee. See Attachment here.
Is the fee refundable if I move or simply decide this practice model is not right for me?
- Yes, the Membership Fee covers services available to you while you are in the Practice and you can cancel anytime
Do I have a copay?
- There are no co-pays for services covered under the flat fee. For any visits or other services beyond those covered under the membership fee, the practice will collect a per-service fee as indicated on the attached description of services.
Becoming a member
How do I join?
- You may start the process by going to the website www.criterionmedicalpllc.com and join the Enrollment list. You will then be invited to self-schedule a meet and greet on the calendar by sending our office an email at [email protected] to request an enrollment package. If accepted into the Practice, you will need to sign a Patient Agreement and submit payment of the initial registration fee in order to become a member of the Practice. Patients will be accepted in the order in which they join, and once the Practice reaches 150 members, no additional patients will be accepted into the Practice until a spot opens up.
What is the Enrollment List?
- We are maintaining a Enrollment List of patients who want to be guaranteed the opportunity to enroll as a member. Because we must keep our patients to a limited number and ensure our premium patient-focused care, we encourage you to sign up today with no fees or obligations
When can I join?
- Our enrollment period has begun and we started accepting payments and scheduling patient appointments. We expect to reach capacity very quickly, so we strongly encourage you to join the Enrollment List so you are guaranteed the opportunity to enroll.
Can I meet the physicians at Criterion Medical before I commit?
- We would love to schedule a brief 15 min introductory visit with our physicians so we can get to know each other and make sure our practice is the right fit for your healthcare needs. This informal meet-and-greet gives us both the opportunity to ensure we can provide the personalized care you are looking for
When will the Criterion Medical office open?
- We are scheduling patients from 9/1/2026 onwards.
Is it possible to be seen at Criterion Medical without signing up for a membership?
- We offer a limited number of non-member appointments for acute or urgent concerns, including pre-operative evaluations, subject to availability. To ensure we provide the highest quality care and proper follow-up for our patients, we generally cannot accommodate one-time visits for routine wellness exams, mental health needs, ongoing chronic conditions, or second opinions.
- Non-member visits are $300 per appointment (tests and procedures not included) and must be paid at the time of service.
- Please note: Non-members do not have direct access to Criterion Medical Physicians outside their scheduled appointment.
I have a few more questions. What should I do?
- You can contact us at our email at [email protected] or call Criterion Medical at (845)-595-4913.
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