Frequently Asked Questions
  
What is Direct Primary Care?

Direct Primary Care, or DPC, is a model that provides care to patients without including a third party payer; the patient pays the doctor directly. This  reduces the number of patients the doctor sees and allows for patients to not be rushed through appointments and to receive care when they need it. It also allows for the doctor to be consistently available to the patient to provide comprehensive care. The doctor-patient relationship is the focus.

What services are included?

  • Unlimited visits, no copays, same-day office availability
  • In-office procedures and tests, including EKGs, urinalysis, spirometry, repair of minor lacerations, removal of benign skin lesions and warts, skin biopsies, pap smear and well woman care, abscess drainage, cryotherapy, flu test, and strep test
  • Pre-op exams, diabetes management, hypertension management, wellness planning, weight management, comprehensive physical exam, smoking cessation, and chronic illness management
  • Basically all of your primary care services are available. The only things that may incur extra costs are vaccines and supplies needed for procedures, which will now be billed at the cost we pay for them
  • 7 day a week availability to communicate with the doctor by phone and email

Is this concierge medicine?

No. They are similar in that both models strive to make the patient experience better by making the care more personal and allowing for more time during the office visit. The difference is in cost and billing structure. Concierge practices bill the insurance companies AND charge the patients a yearly fee. The typical DPC office charges the patient between $50 and $100 per month and does not bill insurance.

How much does it cost?

There are three prices based on age.
  • 18-39 $50 per month
  • 40-64 $75 per month
  • 65 and up $100 per month
Couples will not be charged more than $150 total for the monthly fee. 

How and when do I sign up?

You may sign up at anytime, there is a $100 enrollment fee per person. 

Do I still need health insurance?

Yes, direct primary care is not insurance. We recommend that patients still carry at least some type of major medical plan or catastrophic insurance. Every person is different with different medical needs and financial situations. What insurance coverage you purchase is up to you and your personal situation.

I have Medicare, so what does this mean for me?

You should keep Medicare. You can have Medicare and a DPC doctor. We will not be billing Medicare for any services, and you may not submit the fee to Medicare for reimbursement. Dr. Emmons will still be able to order medications, labs, and imaging, as well as send you to specialist. All of those services will still go through Medicare, as those providers will still be contracted Medicare providers.


Will you create a form I can submit to my insurance company to be reimbursed? /Can I submit charges?

No.

Will you still be able to order imaging or labs or send me to a specialist if needed?

Yes, that will not change.

How does this work with my current insurance?

Dr. Emmons will still be able to order lab work, testing, and imaging and send referrals for patients with Medicare and most commercial insurances. We will also work diligently at completing prior authorizations when one is required. It is best to check with your specific insurance plan to determine how seeing an out-of-network doctor will affect these things. None of the care provided by Dr. Emmons will be billed to your insurance or paid for by insurance.

Can I submit charges to my insurance company for reimbursement?

No

Is the payment tax deductible?

Unfortunately, no. Your retainer is not yet defined as a “medical expense” in most states and as such is not deductible. The American Academy of Private Physicians, however, is lobbying hard to win rightful deductibility for these expenses. In the meantime, consult with your tax consultant to clarify tax consequences in your particular circumstances.

What if I need to go to the hospital?

The hospitalist doctors will be the ones taking care of you in the hospital. If needed, Dr. Emmons will be happy to be a source of information to the hospital doctors and help coordinate your care in the hospital.

What if I need medical care while I am away from home?

Naturally Dr. Emmons will try and provide such care, yet another freedom we enjoy together as a result of independence from the restrictions of third-party payment. We know you well, and therefore we can streamline your care when you’re sick away from home. Many illnesses can be diagnosed and treated with a simple conversation by phone, email, or text. We’ll locate the nearest pharmacy and order the medications most appropriate for your circumstances.

Can I just have a visit without becoming a member?

No. To keep things simple and consistent for all of our patients, visits or care are not provided outside of our standard membership system.  

Are there any contracts or commitments? What if I decide to cancel? 

We do not require patients to sign any contracts that commit them to a period of membership longer than a month. Memberships are ongoing and open but must be paid ongoing in order to maintain service with us. If you decide to cancel you may at any time. 

May I re-start my membership after canceling?

We do allow for re-enrollment after cancellation, but members will be charged an enrollment fee of $100 per member before service can be restarted. All enrollment paperwork must be completed again, and if there is a waiting list, you will be put on that list.  You will be treated as a patient signing up for the first time.