What is Direct Primary Care?

 

Direct Primary Care (DPC) is an affordable, insurance-free option for most of your Primary and Acute Care needs.  Regardless of insurance status, in the DPC model patients pay a low monthly fee and contract DIRECTLY with their doctor for access.  Very much like a gym membership- and just as important for your health!  It’s simple and straightforward.  There are no middlemen, no hidden fees, and no copays. 

Appointments for members are available and unhurried, your doctor really gets to know you, and it’s easy to reach your doctor when you need them via phone or text.  Many day-to-day issues can even be handled virtually!  All care provided by your DPC doctor is *included* in your monthly membership fee, as are most in-house lab tests and minor procedures. 

You’re still able to use your insurance to cover referrals and out-of-office testing, of course.  And if you happen to be uninsured, your doctor works hard to find you the most affordable cash-pay options available. 

 

Is DPC for me?

 

Whether or not you have health insurance, Direct Primary Care (DPC) may be for you!  Because DPC is an insurance-free model, we don’t have all the overhead associated with medical coding, filing claims, submitting pre-authorizations, etc.  This means that we can offer highly personalized Primary and Acute Care, and spend our time WITH OUR PATIENTS instead of doing paperwork. It’s basically a return to old-timey doctoring, but with modern medicine.

Some of the advantages of DPC include:

-an all-inclusive, low monthly rate ($75-115/mo)
-group discounts for small businesses available

-unlimited office visits 

-unlimited acute care

-Primary Care visits are unhurried (30-60min)
-same or next day appointments are typical
-easy access directly to YOUR doctor, even after hours
-optional telehealth visits

-house calls available (at Dr. G’s discretion)

-focus on wellness and prevention

-most  in-office testing and minor procedures included

-in-office phlebotomy means usually no need to go to the lab
-up front, transparent pricing, no hidden fees, no copays

-heavily discounted cash pay prices for many common prescriptions and tests

Sounds a lot like how medicine is *supposed* to be, doesn’t it??? 

 

Is DPC the same as concierge care?

 

Direct Primary Care (DPC) isn’t concierge medicine, but it often feels like it!  The two models do have some things in common- like you can usually communicate with your doctor via phone/email/text in both models, both models are membership-based, and both models allow doctors to see fewer patients and spend more time with each of them.   But, DPC is generally a more affordable, low overhead/low volume model, whereas concierge medicine tends to be high overhead/low volume. I like to think of DPC as "blue collar concierge" or "concierge lite." 

Many (not all) concierge practices also still bill a patient's insurance in addition to charging a membership fee.  That’s okay.  That’s what makes their model work for them.  The "direct" in DPC means we don't do that though.  It's precisely by cutting out all that overhead associated with billing insurance (coding, claims filing, pre-authorizations, etc.) that we’re able to make our model work for us.  Furthermore, while many (not all) concierge practices are affiliated with large parent corporations, most DPC practices are truly independent, local, small businesses.

 

How much does it cost to join a DPC practice?

 

A basic tenet of DIrect Primary Care is upfront, transparent pricing. We believe that quality care shouldn’t have to break the bank. At ColGACare, our rates are published right on our website: Pricing

The membership rate includes unlimited office visits including acute care, all in-house phlebotomy and minor procedures, free telehealth, optional house calls, and expanded access to Dr. G. Members also benefit from heavily discounted rates on many lab tests, medications, and ancillary studies, as well as discounted acute care services for the children of our members.

There are no co-pays, and no hidden fees. Any extra testing recommended will be discussed with you in advance including its cost.

 

Do you take insurance?

 

Thankfully, no.  Direct Primary Care is about removing the middlemen and restoring the doctor-patient relationship.  We do not take any form of commercial insurance or Medicare. We do not submit any bills to any insurance companies. We strive to keep our monthly fee vastly affordable out-of-pocket.  There are no hidden fees and no co-pays. Membership is a flat rate that includes most of your primary and acute care needs. If you have insurance, you can still use it for outside testing or specialist visits. Any and all pricing for additional services will be made clear and discussed with you prior to proceeding.
 

Is it true that DPC can SAVE me money?

 

Yes! Most definitely. Direct primary care doctors work hard to provide affordable solutions for their patients. We are always on the lookout for deals and coupons on tests and meds to save YOU money. Oftentimes the cost of a DPC membership PLUS a high deductible car accident/cancer/catastrophe (“3C’s”) insurance plan adds up to LESS money spent out-of-pocket than you would pay on premiums, deductibles, and co-pays for your “bells & whistles” insurance plan.

 

So how does it work if I do have insurance?  What can I use it for?

In DPC, we do our best to be available for you and keep you healthy. Unprecedented access to a doctor who really knows you can often mean keeping you OUT of the ER or hospital.  We have a  network of specialists with whom we can consult on your behalf when an in-person exam by the specialist is not necessary. That being said, there will inevitably be occasions when you may need to go to the ER, be hospitalized, have surgery, or see a specialist in person. This is when it’s really nice to have that “3Cs” insurance coverage we talked about. Dr. Galer can handle many things, but she’s not taking out your appendix in her office! 

So if you need to be referred to a specialist, and they take your insurance, you're more than welcome to use it with them.  Additionally, if you need costly studies  or procedures, such as an MRI or a colonoscopy, you can usually use your insurance for that as well.  Of note, PPO plans are generally a better fit with DPC than HMO plans though, because with a PPO plan Dr. G is still able to be your ordering physician for things like that.

You can also still use your insurance for prescription medications, if needed.  Although, truth be told, many common prescriptions actually cost less than your standard co-pay.  If you want to use your insurance, we just fax in your prescription to the pharmacy of your choice, just like usual.  But, Dr. G also buys meds in bulk at wholesale prices, and passes those savings on to her patients.  In fact, it's not unheard of for a patient to be able to pay for the entirety of their DPC membership with money saved by NOT using their insurance for prescriptions.  For example, a patient of ours paid $11.99 using their popular Medicare plan for a 30 day supply of aspirin.  Through Dr. G, that same prescription was $0.58.  A 30 day supply of Prozac, through us, was $1.41.  Three months of oral contraceptives?  $18.08.  Two months of Lipitor? $2.94.  You get the idea.  Insurance companies would have you think you're saving big bucks because you "just" have a co-pay, when really the co-pay is sometimes more than the meds!  Craziness.  There are some meds that ARE expensive though, such as EpiPens, or Symbicort, for example.  And insurance can be super helpful for those.

 

Can I still join if I have Medicare?

 

Absolutely. Dr. G is opting out of Medicare. You will need to sign a one-time waiver declaring that neither you nor Dr. G will directly bill Medicare for our services. Although Medicare will not pay us for any services provided by our practice, your Medicare benefits are otherwise unchanged and you may use them for any other medical care received outside of our practice, such as any specialist referrals or any ancillary testing recommended.

Even though a DPC membership must be strictly out-of-pocket for Medicare patients, many still choose to join in order to avoid long wait times and administrative hassles so prevalent in corporate “healthcare.” A meaningful relationship with and easy access to a physician who knows them can often prevent an unnecessary ER visit or hospitalization. The money saved right there can then cover months, if not years, of DPC membership costs.
 

Is DPC a replacement for health insurance?

 

Definitively, no.  A DPC membership IS NOT insurance and isn’t intended to replace insurance. A DPC membership is a great way to see that most of your medical needs are met, but we still recommend you have a plan for hospitalizations or major health issues. Direct Primary Care is an option that offers a great complement to insurance *when insurance is used as…. insurance.*

Let’s expand on that.

The whole point of insurance is to make sure you’re covered in case of an unexpected, expensive, big-deal event, like cancer, a car accident, or some other medical catastrophe. I call those the "3C’s.” Cancer, car accidents, catastrophes. It works because the number of people that have something really expensively bad happen to them is only a fraction of the total number paying into the pool.

Primary care is NOT an unexpected, big-deal event. We’re SUPPOSED to see a doctor a few times a year. It’s NORMAL to need some minor acute care on occasion. It’s BETTER to prevent poor health than to treat it. These are basic healthcare needs that are entirely predictable and expected. That’s the opposite of what insurance was designed for. Primary care isn’t expensive. Why is insurance even involved?

Using your health insurance for such predictable, routine, completely expected matters would be like filing a claim on your homeowner’s insurance not just when your house burns down, but also every time you call a plumber or get your lawn mowed. It would be like filing a claim on your auto insurance every time you get your oil changed or tires rotated or even fill up a tank of gas. If people did that sort of thing those industries would break down, right? Because it would be ridiculous, right? Because that’s NOT WHAT INSURANCE IS FOR, right? Responsible adults budget for routine, anticipated expenses and keep a little in reserve for when they need to call a plumber.

How much could you save on your premiums if you narrowed your coverage to only the unexpected? Enough to cover your DPC membership? More, and you could pocket the difference? What value would you place on NOT to having deal with insurers and copays and just being able to text your doctor when you need them?

This. Is. DPC.