Annual Administrative Fee

Effective January 1, 2026, AFM Healthcare will implement an Annual Administrative Fee for all non-Medicare patients with commercial insurance. This fee supports the practice by covering non-covered services that are not reimbursed by insurance but are important to maintaining comprehensive, accessible care.

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Annual Administrative Fee for Non-Covered Services

At AFM Healthcare, our mission has always been to deliver exceptional, compassionate, and personalized care. For over 45 years, we have been honored to serve our community, and we are committed to keeping our doors open to all who trust us with their health.

However, the reality of today’s healthcare environment is that the resources required to maintain the high standard of care you expect from us is not fully covered by insurance reimbursements.

While the scope of what we provide our patients has grown, including more direct communication, proactive outreach, and behind-the-scenes work to support your health, most insurance companies have not kept pace with these changes. For example, Florida Blue, United Healthcare, and Cigna have increased our reimbursement rates by only about 1% in the past decade, despite rising costs, inflation, increases in insurance expenses, cost of living, salaries, and fuel prices.

To continue providing the level of service and access that defines our practice, effective January 1, 2026, we will implement an Annual Administrative Fee for all non-Medicare patients. This fee will be $100 per year for adults age 18 and older, and $50 per year for minors under 18. The fee is collected once per calendar year and is due at the beginning of the year.

This annual fee helps offset the cost of valuable, non-covered services that insurance does not pay for. It supports patient education and guidance outside of visits, access to timely follow-up and non-visit-based communications, assistance with navigating insurance-related questions and requirements, behind-the-scenes coordination to ensure smooth and efficient care, and general administrative services necessary to sustain our operations.

In addition, this investment will allow us to focus on improving timely office visits and reducing wait times something, we are actively working toward to make your experience even better.

These services are essential to running a responsive, modern primary care practice, yet they remain outside the scope of what insurance companies reimburse. Without this support, many of the conveniences and efficiencies our patients have come to expect would be difficult to maintain.

We understand this is a change, but it allows us to invest in staffing, technology, and processes that directly benefit you, ensuring we can continue to deliver sustainable high-quality care in a timely and personal manner.

The chart below, provided by the American Medical Association, highlights the issue of insurance underpayment. While the red line represents Medicare payment rates, it is important to note that all non-Medicare insurance plans structure their reimbursement rates as a percentage of Medicare’s Rates.

As the graph above illustrates, inflation has increased by over 80% since 2001, yet Medicare reimbursement measured through the conversion factor has actually declined by nearly 10% over the same period. This widening gap reflects the reality that insurance payments are not keeping pace with the true costs of delivering care, including staff salaries, technology, rent, administration, and the personalized services you rely on.

This means that when Medicare rates fail to keep pace with rising costs, the payment rates from private insurance plans are also indirectly constrained, further widening the gap between reimbursement and the real cost of providing care.

If you have questions about this fee or wish to discuss it further, please contact our office. Patients who choose not to participate will be provided a 60-day transition period to select a new primary care provider, ideally during open enrollment.

We remain committed to putting your health first, and this change ensures that AFM Healthcare can continue to be a dependable, patient-focused medical home for years to come.

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