Frequently Asked Questions
WHY IS DIRECT PRIMARY CARE BETTER?
Conventional insurance-based medical practices are becoming unwieldy with more employees and time spent just on billing and collections. Insurance companies dictate the type of care doctors give, and doctors have to see 25+ patients a day to maintain their business. Many times, the cost of billing is more than the fee itself.
Direct primary care allows physicians the freedom to serve patients and practice medicine the way they were trained. No billing means doctors have time to spend with patients, and patients can access the doctor when and where they need to.
Ultimately, direct primary care allows for more than just a better version of what is already there. Doctors are able to redefine the frontlines of care by providing proactive and preventive care that is otherwise unavailable in the traditional system. This leads patients to experience better service while having better health – namely fewer surgeries, specialist visits, hospitalizations, and medications.
WHY DO I NEED MEMBERSHIP TO A PRIMARY CARE PRACTICE?
In the traditional healthcare setting, most people are accustomed to paying the doctor through insurance on a visit to visit basis. The problem is – most primary care is patient-provider dialogue, and it’s hard for insurance companies to know how to reimburse a conversation. This forces doctors to have you come in the office and then charge you every time you want to speak with them or follow up. Recently, doctors have needed to see upwards of 35+ patients a day just to keep their practices solvent.
In the DPC membership model, doctors are free to dialogue when, where, and how long the patient needs at no extra cost. This significantly increases the level of service and care a patient receives from their doctor. So much so, that in one study patients in a DPC membership model experienced:
- 40% Less ER Visits
- 54% reduction in ER costs
- 24% Less Hospitalizations
*Society of Actuaries, 2020
I have chosen a membership model because it’s affordable to the patient and allows me to take care of my patients (whom I love!) in the best way I know how.
DO YOU HAVE EVIDENCE THAT DIRECT Primary care COSTS LESS?
Numerous reports show better care and cost saving throughout the United States. In North Carolina, DPC saved $1.28 million in health care claims in one year for 2000 patients. Less paperwork for doctors means more time to spend with patients as needed to manage medical conditions. More time means better access which means fewer specialist referrals, hospital admissions, and ER visits. In insurance-based medical clinics, 43% of the day is spent on needless paperwork
My practice leverages a telemedicine app that allows me to be available after hours, especially in urgent concerns. This dedicated tool allows us to securely text, video chat, and send pictures in real time.
HOW ARE OFFICE VISITS HANDLED?
It’s easy – schedule a visit via secure messaging or call in and come into the office to see me when your visit is actually scheduled. You and I also have the option to a televisit as an alternative for a quick checkup or if you’re sick at home and would prefer not to come in. As a member of my practice there are no additional charges to see me-ever!
WILL YOU ALLOW ME TO SEE YOU WITHOUT SIGNING UP FOR A MEMBERSHIP?
You never know what the future holds for your health, so I would always suggest joining for a membership to take advantage of my time to get ahead of any problems that may pop up. If you aren’t sure if a membership is right for you, whether it be financial, for your health, or otherwise, you can always contact me so we can sit down and I can help you work through your decision.
HOW CAN I BE SURE YOU WILL HAVE TIME FOR ME IF YOUR ACCESS IS UNLIMITED
Because my main priority is you and I want to make sure I’m available for you while maintaining little to no wait, same day or next day visits, as well as non rushed, 30-60 minute visits, I cap my patient panel at 600 patients (a traditional panel is 2000-3000 patients).
If you feel you need to go to the hospital, please call and discuss with me at any time. I can help you decide whether it’s something we can take care of or if the emergency room is necessary. As your private physician, I would like to be involved in your hospital care—whether to speak to the emergency room physician or the in-patient doctor to assist in your care. We are also happy to keep in touch with your families during your stay and help arrange for your care after you return home.
Our practice welcomes all patients – no matter what kind of health plan you do or do not have. We like to say everything done within the walls of or by the practice is covered by the membership. If you need to go outside the office – like for labs, blood work, or specialists you can use your health plan like you normally would. If you are looking for a cost-effective way to obtain catastrophic care, we recommend you enroll in a zion healthshare. This new type of health plan is affordable, provides great service, and is actually useful to alleviate any emergency medical bills.
Medicare offers a low baseline of primary care services and typically makes it hard to gain personal access to a primary care physician. My practice is excellent for the Medicare patient who values having unlimited access to a primary care physician that knows them. My Medicare patients pay practice fees directly, but Medicare coverage remains in place for everything else: specialists, testing performed outside of our office, and hospitalizations. Your Medicare will also cover labs services I prescribe as these are performed by an independent lab affiliate. I can still refer, write prescriptions, and fully act as your primary care physician.
HEALTH SAVINGS ACCOUNTS (HSAs)
Some patients utilize their health savings (HSAs), flexible spending (FSAs) or health reimbursement accounts (HRAs) to pay our fees as “qualified medical expenses.” Legal experts have recommended these patients follow the best practice of paying annually or semi-annually. If requested, we can provide you with an invoice and/or submit a notice to your employer if any questions arise about our programs. Please note that we cannot provide tax or legal advice, and you should consult your own tax advisor for guidance.
My service contract is for one year. If you are unhappy with the services OR for any reason wish to cancel your contract, you may do so with a 30-day notice. Any services already performed (i.e. preventive exams) will be itemized for payment. Any refunds will be granted after the service items are paid. All contracts are automatically renewed unless a 30-day notice is received by us not to renew.
You may pay with cash, credit or check. For convenience, keep a credit card on file for incidentals and make it easier for you to make monthly, quarterly, biannual or annual payments.
WILL THESE CHANGES TO YOUR PRACTICE COST ME LESS?
The only change is that I’ve partnered with resources that may save you additional money if you would like to pay cash rather than submit to insurance. For example, I’ve partnered with labs, imaging centers, and a prescription wholesaler for dramatically lower cash-based pricing. However, if you still would like to submit to your insurance you are welcome to do so. I can provide you with those options that allow you to make the right decision based on your situation.
DO YOU ACCEPT INSURANCE?
I accept patients as members no matter what insurance they have or do not have. I do not bill insurance. Because of this, to your insurance, this practice will be considered “out of network”.
If you desire, I will work with you to submit claims on your own and help you get reimbursed by your insurance company. How much you are reimbursed is dependent on your specific insurance plan and carrier.
HOW DO I PAY?
You may pay with cash, check or credit card. I request a credit card on file through our secure business vendor to enjoy a cash-free office environment. The membership is completely inclusive for in-office care including visits, and I can charge your credit card directly if you choose to do any lab work or imaging at cash prices (not through insurance).
If you are going to use your Health Savings Accounts—payment needs to be every 6 months or yearly.
WHAT ABOUT LABS, IMAGING, AND PRESCRIPTIONS?
The only change is that I’ve partnered with resources that may save you additional money if you would like to pay cash rather than submit to insurance. However, if you still would like to submit to your insurance you are welcome to do so. I can provide you with those options that allow you to make the right decision based on your situation.