GENERAL QUESTIONS

Direct Primary Care (DPC) is a model in which your DPC doctor (Dr Mark) has decided to stop participating with any insurance plans (private or public) in order provide the patient (you) with more direct comprehensive health care. This is done by having the patient pay a monthly fee directly to the practice (Whole Family Direct Care).

The traditional model of medicine often has patients paying higher and higher premiums in addition to higher and higher deductibles. Because of this, they cannot get into the doctor’s office in a timely manner, and many times cannot see their own physician. Meanwhile, physicians are forced to spend more time and resources on increased data collection and documentation demands. This is not only more costly and time consuming but intrudes on patient privacy. The end result is frustration for both the patient and physician.  

By adopting the DPC model, physicians can avoid these intrusions by the insurance companies and, instead, spend more time directly engaged with the patient and advocating for them. Also, because there is no “insurance middle man,” many labs, medicines, and other tests can be significantly cheaper. All of this allows for a more favorable experience when seeing the doctor.

First of all, congratulations on being healthy. That is the goal we are aiming for. However, chances are you will get sick at some point throughout the year. Wouldn’t it be nice to be able to easily contact YOUR doctor by text or a quick phone call to get some advice? Perhaps we can keep you out of the Emergency Room and be seen next day at your convenience with less wait time.

In the current model, many people end up in the Emergency Room or Urgent Care spending $150 – $200 just on the co-pay. Because these doctors are not familiar with you, additional costs are generated with the x-rays and other tests that may not have been needed. One visit to the Emergency Room could equal the cost of a large portion of your membership for the year, and you still didn’t get to see the doctor you prefer. Often times, after an ER visit, you are sent to your Primary Care doctor for a follow up visit. This means you will have one more copay added to your overall cost.

Dr. Mark will see patients from birth through death. He will continue to deliver babies and care for the newborns in the hospital as well. He will practice true, full spectrum Family Medicine.

Call our office for information.

No! First off, concierge medicine has traditionally participated with your insurance company but have asked for a monthly fee to maintain their services. This means they still have to deal with the same insurance demands and intrusions that DPC tries to avoid. Furthermore, the cost of the monthly fee tends to be higher than a DPC practice giving the perception that it is only an option for the wealthy with good insurance.

DPC also requires a monthly fee but generally at much lower prices and does not participate with insurance. So patients from all walks of life have more access to their DPC doctor.

This is exactly when you need your insurance. The hospital will provide the care you need and will bill your insurance accordingly as they always have. However, upon discharge, Dr Mark and the hospital will want you to be seen as soon as possible in the office. There is no extra fee to be seen and Dr Mark will be able to get you in more quickly. This is an important time. We all want you to stay out of the hospital so having more time to sit with Dr Mark and review any medication changes, coordinate the care started in the hospital, etc. can be critical. If you need to be seen multiple times in a short time span as you recover, rest assured there are no additional fees. Now you have another copay to add to the overall cost.

MEMBERSHIP QUESTIONS

The fee covers all the basic primary care you have been used to in the office but without any hidden fees. This includes:  annual wellness exams, well child exams, sports physicals, school physicals, work physicals (unless work mandates something additional), chronic care office visits, follow-up visits, basic office procedures, and treatment of acute illnesses and minor injuries. However, modern technology also enables us to enhance the relationship. So at no additional cost, we can have more direct communication using our phones, text, and email. We can also video chat but remember this is as a way to enhance the doctor patient relationship and not to replace an office visit when needed.

Additional fees will cover access to labs, certain in-house imaging (x ray and ultrasound), and special procedures at a discounted rate for members. Otherwise, you may utilize your insurance for services like lab and imaging.

No, we do not require a sign-up fee for a household, family or individual. However a re-enrollment fee ($150/ re-enrollment) may apply for members who have cancelled and decide to return.

First and foremost, there is NO cancellation fee. I want to have an honest and respectful relationship with each and every patient. It will be our goal to find a resolution to any dissatisfied patient, but in those cases when none can be reached we simply ask for 24 hours notice of termination. The monthly membership fee will be prorated and a refund will be given for the remainder of the month.

However, if you decide to rejoin then the re-enrollment fee ($150/re-enrollment) will apply.

A variety of options will be available from direct payment with a credit card (similar to how many of us pay for our phone bills) to more traditional options such as by check. Although it is designed to be paid on a monthly basis, membership fees can be paid quarterly or yearly. The contract will continue to roll over/ renew monthly unless terminated.

MEDICARE & INSURANCE QUESTIONS

Of course! Federal law states that we all must have insurance. None of the services provided at Whole Family Direct Care will be billed to your insurance, however, you can use it for your labs, medications, x-rays, hospital stays, etc.

Most people have out of pocket fees with insurance such as co-pays, co-insurance, non-covered services, out of network charges, etc.  In a sense, you are already paying twice for services in the current model. Under the Direct Primary Care model many labs, imaging tests (x-ray and ultrasound), can be billed to you at wholesale cost. For example, you can decide if it makes more sense to pay a cheaper rate for a specific lab through Whole Family Direct Care or use your existing insurance and receive a mystery bill with hidden fees and costs several months later.  

The best advice would be to check with your health plan, insurance broker, or employer to find out your options. HSAs and FSAs are a great way to pay for your health care needs with pre-tax dollars. IRS regulations make it pretty clear that all DPC services are covered medical expenses reimbursable through HSAs and FSAs. But here is the catch, the IRS claims that DPC memberships are health plans, and therefore fees are not reimbursable when employees combine DPC with any other “health plan”. Now let’s make it even more complicated, the Affordable Care Act (Obamacare) and several state laws contradict the IRS stating DPC is NOT an insurance plan. Currently the issue is being addressed at the Federal level with legislation that was just re-introduced in January 2017. DPC, HSAs, and FSAs can work together nicely especially for covering your labs, meds, and other radiological tests. However, the DPC model is new to many in this area including your health plan, insurance broker, and employer so discuss your options clearly with them.

Come on board! You still get the same membership benefits as everyone else. However, your monthly membership cannot be submitted to Medicare for reimbursement and you must sign a waiver every 2 years stating neither you nor your doctor will directly bill Medicare for the membership fee.  

In fact, you are able to see the doctor of your choice. Many patients have become disillusioned with healthcare for a variety of reasons. Many of them are related to poor accessibility. Medicare patients often have multiple medications or other needs. They want consistency and now they can get in to see THEIR doctor without all the long waits.