DIRECT PRIMARY CARE MEMBERSHIP

No, fortunately for both you and us. Perhaps the most critical distinction in our model of care centers on a direct, personal relationship between you and your doctor. That directness carries over to our business model as well. You might use your auto insurance to fix a smashed fender or other major damages, but you’d never use it to get an oil change (or pay for gas!). For some reason, we’ve become accustomed to using health insurance for the equivalent of oil changes for humans – primary care: routine physicals, office visits, simple blood tests, and minor procedures. This just doesn’t make sense.

We forego insurance payments in order to save our patients from the arbitrary, intrusive decisions that come with using insurance. Charging a direct monthly fee frees us from the typical contractual agreements and billing overhead that prevent non-DPC physicians from offering wholesale prices on laboratory tests, imaging, and medications.

Yes. We take care of any patient regardless of your insurance situation. Since we work completely outside of the insurance system, none of the billing for care here is eligible for insurance reimbursement. However, we recommend that everyone have insurance coverage, which is still important in the event of a major injury or illness.

Yes. We recommend our patients continue a major medical plan with a high-deductible. If you experience a major health issue, you will still need insurance to help cover it. We’re happy to refer you to insurance brokers who can help customize an insurance plan to your specific needs.

For starters, having such unprecedented direct access to your doctor will help prevent hospitalizations and specialty referrals in many cases. However, when those types of care are required, we will certainly continue to work with your hospitalist during your hospital stay, as well as work closely with any specialists. Depending on the level of care and sorts of expertise required, we may rely on those specialized caregivers to manage your treatment.

Yes. You need only sign a one-time waiver declaring that neither you nor your doctor will directly bill Medicare for our services. Even though Medicare will not pay us for any services you receive in our practice, your Medicare benefits will otherwise remain unchanged and can continue to be used for all other medical care received outside of our practice. Medicare will still cover any laboratory testing, imaging, medications, or hospitalizations prescribed by our office.

As the Affordable Care Act was being drawn up, several doctors worked very diligently to insert into the health reform bill a clause that recognizes Direct Primary Care practices as a legal, medical entity. However, a DPC membership alone does not meet the minimum coverage requirements of the Affordable Care Act. The best option for our patients will be an “exchange qualified” major medical type plan combined with a DPC practice like ours. This combination will save the maximum amount of money while also allowing for a maximum amount of health care coverage.

You may want to check with your human resources department regarding the use of Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) as possible payment options for your membership. There is currently legislation under consideration at the Federal level that will allow for limited use of HSA and FSA funds to be used for DPC membership fees.

Unfortunately, no. Your retainer fee is not yet defined as a “medical expense” in most states. As such, it is not deductible. Please confer with your tax consultant to clarify tax consequences in your particular circumstances.