The unique nature of direct primary care does frequently present many questions. Ironically, its simplicity often creates confusion. If you have questions which are not addressed here, please email Kara through the Contact section. We love to talk about this model and how it can benefit anyone.
Simply put, the direct care model just doesn't work that way. It works to keep the costs down for everyone because everyone is paying every month. This allows the total membership to stay relatively low, which allows for the accessibility, long appointments, and no waiting. Cash fee-for-service results in volume-driven reimbursement, just like traditional practice, which requires more patients and less access and time with the doctor. When revenue is no longer dependent on high volume, the volume stays low and access remains high.
That is one of our favorite questions. As more and more people are discovering each year, especially under Obamacare plans, having insurance and having access to care are completely different. You are paying for the personalized service that is not available in fee-for-service practices, at a fraction of the cost of concierge practices that still bill insurance and therefore have much higher overhead expenses. I invite you to see the "About MyDPCdoc" page to read about "the costs of NOT having a DPC physician".
Since direct patient care is not an insurance plan, you still need to carry insurance that covers you if you have a high-cost health event or need expensive tests. Whenever you need labs or xrays, or if you have to go to an ER, specialist or hospital, you would use your insurance for those items. If you don't have insurance I can help guide you to the services that are least expensive; there are very affordable options for labs and xrays for those who have no insurance. And your access to me can help ensure that you do not need costly urgent care visits. I also have the time to discuss your care with specialists, and sometimes this can preclude the need to visit the specialist or have an expensive imaging study.
My opting out of Medicare has no effect on your Medicare coverage for all other providers who accept Medicare reimbursement. It is necessary for me to opt-out of Medicare so that I can have a private, monthly fee-based arrangement with you. In fact, Medicare is the ideal complement to a direct patient care practice because you are covered for everything else outside of my services. I am approved to order labs, xrays, home health services, DME, etc for all Medicare patients (except those with certain "Medicare Advantage" plans that require an "in-netork PCP"); I just don't bill Medicare myself.
The tax laws regarding the use of FSA and HSA cards are evolving. You can't use an HSA to pay insurance premiums; prior to the Affordable Care Act, the monthly fee in a direct patient care practice was viewed in a similar way as an insurance premium. The ACA specified that direct primary care docs are not insurance companies, but the tax laws are evolving more slowly. So you should consult with your accountant before using an FSA or HSA card to pay the monthly fee as the tax laws surrounding their use are expected to change in the near future. We will provide a detailed receipt that outlines the services rendered for the monthly fee in order to facilitate the use of FSA/HSA funds; however it is your responsibility to make sure you are using these tax-advantaged accounts appropriately.
I am happy to get prior approval for any medications or diagnostic studies your insurance requires. However, I am not an in-network physician on any insurance plans, so if your plan is an HMO that requires authorizations to be done only by in-network physicians, I would not be able to do this and you would need to see the primary care doctor to whom you were assigned, and pay the office visit copay, in order to get an authorization. I am not aware that any insurance plans require that medications be prescribed by an in-network physician in order to cover them, but if you have an HMO you should be sure to verify that. Plan requirements change every year.
Immunizations are not included as part of the monthly fee. All of the common adult immunizations are now offered at most local pharmacies and I would provide a prescription in order to have that done at the pharmacy. Some pediatric immunizations are now given at the pharmacy; the remained are given at the local health department.
Great question. We have a network of over 30 physicians thoughout Florida that provide DPC to small to medium-size employers. If you introduce us to your employer and they add DPC to the plan, your membership would then be no cost to you. This is how we are attempting to scale the DPC model. We would appreciate an introduction to your employer if all the employees are in Florida.
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