Here’s a thought experiment: what if you took all the worst parts about healthcare in America – insurance companies and their mountains of paperwork, corporate hospital systems that don’t care about patient satisfaction, and all the middlemen trying to eliminate price transparency – and you threw them all out the window. That is DPC in a nutshell.
By cutting insurance out of the picture, eliminating administrative costs and price gouging, your provider will have more time to stay on top of your health: running preventative tests, diagnosing you when you are sick, and quickly addressing any health concerns or questions you have, no matter how long the visit may take.
Enjoy a personal relationship with your provider. Unlimited care via text, email, or phone, as well as same-day or next-day availability!
DPC cuts out the middleman – insurance providers – and offers instead a flat monthly rate that covers the cost of your care. No co-pays or deductibles!
Save money with wholesale prices on prescriptions and lower negotiated pricing for tests, labs, and scans.
Functional medicine, preventative care, chronic disease management, minor in office surgical procedures, care coordination, personalized wellness plans, episodic care, medication refills, and labs. Visits are unrushed, and typically 30-60 minutes.
We focus on wellness which in turn decreases ER visits, hospital admissions, and specialty referrals, which can affect your physical and financial wellness.
Put simply: your DPC provider is there when you need them. You get unlimited office visits at no additional charge—and they’ll be as long as you need. Typically you’ll be able to book a same-day or next-day appointment, sometimes directly through the practice’s website. You’ll have access to your providers cell phone number, so you’ll be able to call or text them any medical questions as needed. Some simple diagnostics (e.g. strep tests) and blood tests may be performed in office for a small additional charge (or no charge at all). If you have a major issue, your doctor will coordinate any specialist referrals or hospital care.
The typical monthly fee is about as much as your internet bill. That’s a small price to pay for a level of care you literally can’t get anywhere else.
Not to mention: the membership fee can often pay for itself. Most DPC practices have an established relationship with local laboratories and radiology centers. That means you can get blood tests, pathology screens, X-rays, MRIs, and more for low cash prices. Our DPC practice will also dispense medications in-house at near-wholesale prices, so you can both save money and avoid extra trips to the pharmacy. Plus, as a DPC member, you may be able to save a lot of money on insurance by switching to a high-deductible plan.
In short: being a member of a DPC practice is like having a doctor in the family. Your doctor will always be in your corner, working to keep you as healthy as possible. It’s an amazing feeling.
Right now, you already do! You pay an insurance premium and then any further fees up until you meet your deductible. As a DPC member, rather than pay higher insurance based rates towards a deductible you may never meet, you pay a flat rate for all your primary care services. There are no copays, surprise bills, hidden fees, or unknown extra charges. Your membership covers annual labs, in-house testing and procedures as well as comprehensive consultation and follow-up care. If you have not met your deductible and we do not provide a necessary service, we can help to find you the best prices for that service and help coordinate your care with outside services.
You bet! Let’s go over some common scenarios where a DPC membership can save you money.
#1 You’re taking multiple medications.
If you’re taking multiple medications and paying with insurance for all of them, your co-pays are probably stacking up. Direct primary care practices frequently dispense common medications directly from their offices, so you won’t need to do an extra trip to the pharmacy. Plus, your DPC doctor will purchase these medications at wholesale prices from a free-market vendor, and they pass those savings through to you. The value of this service depends on which medications you’re taking. Often your insurance provider will only cover a drug from a particular drug manufacturer, or they’ll require you to use a brand-name version even though a cheaper generic is on the market. If that’s the case you can easily be paying hundreds of dollars a month on medications—money you could save as a DPC member.
#2 You get injured. If you get in a minor accident, or fall, or throw your back out, most peoples first acute injury visit is to an ER, minor med, or urgent care clinic. You won’t think to call your primary care provider because you know they are booked up at least a week. So now, your copay is that of an ER visit or specialist, which is what the minor med or urgent care is considered. Then, they often order frivolous lab tests and diagnostic procedures just to determine you pulled a muscle, sprained an ancle, or nothing was wrong at all. If you have a high deductible or significant coinsurance, (which is the price your insurance won’t pay even after you meet your deductible), then you’ll end up with a significantly high bill that could take years to pay off.
#3 You’re overpaying for insurance.
As a DPC patient, the majority of your healthcare will be taken care of by your DPC doctor. All standard care, wound treatment, blood work, preventative screens, and physicals will either be included in your membership or provided at a fair price by your doctor. If your DPC doctor isn’t equipped to deal with a medical issue, it’s probably serious. And if it’s serious, then you’ll very likely hit your out-of-pocket maximum (OOP).
Here’s the thing: the OOP for the cheapest and most expensive plans don’t vary that much. Aetna’s cheapest plan costs roughly $600 per year and has an OOP of $6650. Their most expensive plan costs $4200/year with an OOP of $4000. That means you’d be paying a guaranteed $3600 extra dollars ($4200 – $600) to avoid the small chance of paying an extra $2650 (6650 – 4000) on your healthcare. That doesn’t make sense! Unless you’re expecting to suffer a major health crisis every 9 months, you’ll be better off on a cheaper plan. Otherwise, just join a DPC practice and take the cheapest insurance you can find!
Do none of those scenarios apply to you? Here’s one more:
#4 You care about your health. Direct primary care is the best game in town when it comes to healthcare. Think of it this way: before DPC, only the super-rich were able to afford a personal doctor who works tirelessly to keep them healthy. To keep a personal doctor on staff costs thousands of dollars per month. The rest of us had to a) wait until we were sick before talking to a doctor, then b) schedule a visit weeks in advance just to c) spend 10 minutes with a doctor we’d never met.
With DPC, everyone can have a personal doctor on speed dial for a shockingly low amount. Having a medical expert on hand to answer questions, keep track of your preventative screenings, advise on your diet and lifestyle, and actually care about your happiness was simply not possible before. Now it is.
You may have heard of a similar model called “concierge medicine.” While there are similarities with DPC, the two are different in some fundamental ways. For starters, concierge practices often bill your insurance in addition to a monthly fee (though some don’t—which makes them DPC practices!). This means they’re still a part of the insurance industry’s ridiculously complex reimbursement system, so they have to hire administrators to handle all the paperwork. This gets reflected in your monthly fee; the average concierge practice bills $200-300 per month. By comparison, DPC memberships cost approximately as much as your internet bill. Concierge was a step in the right direction, but it didn’t go far enough. To bring sanity back to primary care, you need to cut insurance out of the picture entirely.
We recommend you continue to have some type of health plan coverage. If you are looking for a cost-effective way to obtain catastrophic care (childbirth, surgery, accidents, etc…), we recommend you enroll in a healthshare. This new type of health plan is affordable, provides great service, and is actually useful to alleviate any emergency medical bills.
Medicare offers a low baseline of primary care services and typically makes it hard to gain personal access to a primary care physician. My practice is excellent for the Medicare patient who values having unlimited access to a primary care physician that knows them. My Medicare patients pay membership fees, but Medicare coverage remains in place for everything else: specialists, testing performed outside of our office, and hospitalizations. Your Medicare will also cover lab services I prescribe as these are performed by an independent lab affiliate. I can still refer, write prescriptions, and fully act as your primary care physician.
Absolutely! To be sure, your DPC provider will always be there for you if you get sick or hurt. But they also work proactively to keep you healthy, happy, free of preventable diseases, and living a good lifestyle.
It’s hard to break out of the mindset of the insurance-based healthcare system. In “the system”, everything is centered around treating illness. It’s very hard for a provider to get paid by an insurance company for detecting early warning signs of diabetes or encouraging a lifestyle change to decrease risk of heart disease. Doctors just aren’t rewarded for encouraging all-around good health.
By being in constant contact with your DPC provider when you’re healthy, you’ll be able to stay that way. By the time you’re being treated for a chronic disease, it’s usually too late. But if you spend your healthy years under the watchful eye of a doctor that cares, you’ll be able to stay out of the hospital for years to come.
We are able to prescribe controlled substances as needed for acute/short-term situations. Since we will be focusing more on getting to the root causes of chronic conditions, we will not be prescribing controlled substances for long-term treatment, but will strive help you find the underlying cause of your symptoms to help you heal completely.
The IRS currently views the DPC monthly fee as a “health plan”, just like a standard monthly health insurance premium is viewed as a “health plan”. According to the IRS, the DPC monthly membership fee is, thus, a second “health plan” and the amount is not a qualified medical expense.