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Frequently Asked Questions
1. What is Direct Primary Care (DPC)?
DPC is a healthcare model where patients pay a flat monthly membership fee for unlimited access to their primary care provider, without the restrictions or complications of insurance-based care.
2. Does DPC replace health insurance?
No, DPC is not a replacement for insurance. It is recommended to maintain a high-deductible health plan for emergencies or specialized care outside of primary care.
3. Can I still use my health insurance if I see a DPC Provider?
Yes, I will not bill or collect from any insurance company, but outpatient labs, imaging, urgent care and hospital services may all be covered by your insurance.
4. What if I have a Medicare, Medicaid or HMO plan?
I can see medicare patients, but only after I’ve opted out of medicare as a provider and the patient will need to sign a waiver declaring that neither you nor your provider will directly bill Medicare for services provided. Medicare should still cover labs, imaging, medications, referrals once this is completed.
Medicaid and HMO plans tend to be very strict about seeing Medicaid and HMO providers only. I cannot write labs, imaging, referrals, or medications for these plans typically, unless I’m a contracted provider through the insurance. You may want to contact your insurance if you do not know if you have a PPO or a HMO plan and what your options are for selecting a primary care provider.
5. What does the membership fee cover?
The fee covers unlimited visits, extended appointment times, direct communication with your provider, and many in-office services, including procedures.
6. Can I still see specialists if needed?
Yes, there will be coordinated referrals to trusted specialists and work closely with them to ensure your care is seamless and comprehensive.
7. What ages will you see?
Age 12 and older.
8. What if I decide to cancel my membership?
I understand needs may change, and I want to help you through whatever transition you are making. The membership is month to month. If you need to cancel, please provide written notice 30 days in advance.
9. Will you have non-membership options
Yes. I understand the month to month membership may not fit all needs. Some individuals would like to be seen once a year for an annual. Non-member agreements do not include multiple visits, telehealth, phone services, medication refills, ongoing chronic disease management. Acute visits may be available, depending on the schedule. Members of course get priority.
10. Can I use my HSA to pay for DPC membership?
The short answer at this time, seems to be no. When the law that created HSAs was passed, Direct Primary Care wasn’t around and wasn’t anticipated. The law states two things: 1) HSAs have to be paired with high-deductible health plans; and 2) If you have an HSA paired with a high-deductible health plan, you can’t have a second health plan. That’s the major problem for DPC practitioners at the moment. The IRS has couched Direct Primary Care agreements between providers and patients as one of these second health plans. It would never hurt to call your insurance company to see if they allow this.