What is direct primary care?
Direct primary care is a model of healthcare where patients contract directly with a physician or physician office for primary care services. The patient’s insurance is not billed for services performed in or by the office, including office visits, telehealth visits, and most in-office procedures
What is covered in the monthly fee?
-office visits without visit fees or co-pays
-home visits (as applicable)
-telehealth visits (video, phone)
-access to your doctor by text, email or phone
-in office procedures included (EKG, spirometry, skin biopsies, joint injections/aspirations, etc)
-whole-sale medications, often at 80-90% savings, dispensed from the office
-access to at-cost labs and imaging in agreements with local labs and imaging centers
What if I already have insurance?
In direct primary care, if you have insurance we recommend you keep your insurance coverage, but instead of becoming the only way to access and pay for medical care, it becomes a tool – one that is used in the event of a catastrophe such as an emergency room visit, hospitalization, or surgery; in other words, you don’t have to use it for every primary healthcare service that you get - oftentimes when you pay directly for primary care services, they become quite affordable. I want to be clear, direct primary care is NOT insurance and I would never recommend for any patient to drop their insurance coverage, but after seeing how affordable primary healthcare is without having to go through your insurance for every service, you might rethink how you utilize insurance and what insurance coverage you need.
Is the monthly fee covered by my HSA or FSA?
At this time, the IRS does not consider primary care monthly membership fees eligible for these accounts, since Direct Primary Care did not exist when these accounts were rolled out. Legislation is being actively considered. As these laws are prone to change, please always consult with your tax accountant to determine the best way to use your HSA funds.
What if I need to see a specialist?
In the event that you need to see a specialist, we have access to a platform called RubiconMD where we are able to get what’s called an eConsult, where we can present the clinical information to a specialist and receive feedback on the case within 24 hours, thus helping to avoid unnecessary consults and save you time and money. If you need to make an in office visit to see a specialist - we are happy to, and can, refer you to a specialist as long as you do not have an HMO insurance plan. In the event that you have an HMO insurance plan, then you would need to see a primary care provider covered under the HMO plan in order to get the referral and we would be happy to coordinate with that provider and explain why we believe the referral is necessary.
If you have any other questions, please do not hesitate to contact our office at 302-722-7082.
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