FAQ—Frequently Asked Questions
• WHat is Direct Primary Care?
Direct Primary Care (DPC) is a low-cost medical practice model where primary care physicians have direct relationships with their patients. The doctor and patient work together as a team to make medical decisions, and DPC doctors are reimbursed directly by their patients, or their patients’ employers in some cases. By removing the time and cost burdens created by health insurance companies, cost is greatly reduced and insurance is no longer necessary for primary care, which is what most patients seek medical care for.
• How is this different from "CONCIERGE" MEDICINE?
"Concierge medicine" often involves higher-paying retainer fees—up to$25,000 per year. DPC is concierge-like medicine but is more affordable—two-thirds of direct primary care practices charge less than $135 per month. DPC membership fees cover the actual cost of care. The end result is that DPC practices are able to provide unlimited access to high-quality primary care for one low monthly fee.
• Is THIS INSURANCE?
No. We ARE NOT insurance. Our clinic and provider do not contract with any private or public insurance plans. You do not need insurance to be a subscriber; however, we encourage all of our patients to carry the appropriate health insurance or be a member of a cost sharing program (like Liberty Direct or Samaritan Ministries) to cover any unexpected situations—like surgery or an extensive hospital stay. With our subscription, you may have more options for less expensive health insurance premium coverage because the majority of your health care needs will be met through our clinic.
If you have questions about getting or changing insurance, I can help you find a good resource in the community. Let me know. Connect for Colorado is a marketplace that opened in October 2013 to help individuals, families, and small employers across Colorado purchase health insurance and apply for new federal financial assistance to reduce costs. In addition to the shopping website, Connect for Health Colorado offers a statewide customer support network of customer service representatives, health coverage guides, and licensed agents/brokers to help Coloradans find the best health plan for their needs.
HealthPocket is a nice informative site that compares and ranks all the health plans available. You can get average out-of-pocket costs, annual premium amounts, and information about co-pays and co-insurance for each of the major plans. There is more information on the Patient Protection and Affordable Care Act (aka Obamacare) as well.
• HOW am i SAVing MONEY?
The combined cost of a monthly subscription fee with us and a lower-cost-premium insurance plan is significantly lower than paying for the higher-cost premium insurance that covers basic primary care needs. This is important when more than three-quarters of the uninsured population are in working families: 63% are in families with one or more full-time workers and 16% are in families with part-time workers. The annual income from a full-time, minimum wage job is only a few hundred dollars more than the cost of an average family insurance plan. For myself and my family (2 children and 2 adults), the premium costs on the Colorado Marketplace range from $8k for the lowest premium Bronze plan to $14k for the highest Gold plan. With our subscription and a low-premium insurance plan, cost to families can drop by as much as 50%, saving hundreds or even thousands annually. Furthermore, what you get from our model is a relationship with a provider, which is key to achieving the right health environment for care and superior health outcomes. This is priceless and nearly impossible to achieve and sustain in the current health care system.
Many employers are now trying to motivate their employees to be as prudent a purchaser of health care as they are of any other product or service. They’re doing this by offering high-deductible health insurance policies combined with health savings accounts (HSAs). When a combination of direct primary care membership and lower-cost insurance policies are paired, employers opting for this combined option have routinely saved 20% - 30% on comprehensive health care benefits over what they currently spend, while employees’ payments (including premium cost-sharing, deductibles, co-payments, and co-insurance) drop significantly.
By having access to a doctor to help triage situations, to be seen when care is needed, and to provide more time as a patient advocate, downstream costs from avoiding unnecessary tests, labs, hospital, and urgent/emergency room care add to these savings. Employers also appreciate the impact that high accessibility direct primary care practices have on lowering absenteeism and improving patient health.
Patients have immediately saved money—hundred of dollars—on the included procedures done in our office, the labs we pay for, discounted labs, and access to discounted medications that can save up to 96% of their retail cost.
• HOW ARE YOU DIFFERENT FROM INSURANCE?
Most importantly we are NOT insurance. Our goals are the same as those of traditional insurance, but the approach to these goals is very different—in the best way. We provide value in primary care by being more available and accessible and delivering high quality, patient-focused attention. We give you unbelievable access to your doctor—same day or next day appointments, access to secured communication, access via telephone and text 24/7. We can help coordinate your care, triage your medical needs, and communicate with specialty physicians on your behalf. We provide less expensive in-office labs, tests, procedures, and treatments—saving 50%–100% in some cases (see Services). We create an environment to support this by building a strong provider-patient relationship and limiting the total patient population per provider.
We strongly encourage all of our subscribers to carry insurance for hospitalizations, surgeries, and other medical care that is outside the scope of primary care.
• I HAVE HEALTH INSURANCE. HOW DOES THAT WORK WITH This model?
We are certainly not a financial or health insurance advisor, but we believe our subscribers work well with high-deductible-type health insurance plans. These plans will save you more money than plans with lower deductibles and higher premiums. Our subscribers who also use health care cost-sharing programs like Liberty Direct or Samaritan Ministries often save 40%–60% on their monthly health expenses.
We can provide your day-to-day services, and your high-deductible or cost-sharing plan can help limit the rare and unexpected expenses of a hospitalization or major health event. High-deductible health insurance plans (e.g., Bronze) usually have 20%–50% lower premiums than low-deductible (e.g., Platinum) plans.
• CAN I GEt REIMBURSED BY MY INSURANCE FOR THE SERVICES YOU PROVIDE?
We do not contract with any private or public insurance plans. If your health insurance plan allows for out-of-network coverage and reimbursement, then you may be able to apply for reimbursement. I would recommend contacting your specific insurance benefits manager or customer service to be sure. We can provide a receipt of your payment so that you can process it with your insurance plan. However, even if your insurance plan will not reimburse you for these services, you will most likely find our prices still save you money.
• CAN I USE MY HSA OR FSA TO HELP PAY FOR THIS MEDICAL SERVICE?
Sadly no. Not at this time. Please call if you have questions about this. Legislation introduced in Congress would correct the oversight and allow HSAs, HRAs, and FSAs to work in conjunction with DPC practices. The Primary Care Enhancement Act of 2015 is pending and must be passed by both the House and Senate and then be signed by the President to become law. Meanwhile, continue to check with your HR manager and/or the HSA, HRA, and FSA administrator.
• WHAT HAPPENS IF I NEED TO SEE A SPECIALIST OR IF I'm HOSPITALIZED?
At present, a hospitalist sees our patients when they are admitted to hospital. Hospitalists are physicians whose primary professional focus is the general medical care of hospitalized patients. We are committed to help prevent hospitalization with early detection of disease and real-time monitoring to catch a worsening disease state. We will refer patients to specialists as necessary.
• DO YOU SEE CHILDREN?
Yes. We treat children from birth to adulthood. I particularly like working with early teens and adolescents. It's a time when I have the ability to influence them about health and well being and to provide education, encourage safety, and discuss their general future.
• DO YOU ACCEPT MEDICARE OR MEDICAID PATIENTS?
At this time, we are not able to accept Medicaid patients. Although we have opted out of Medicare, we welcome Medicare patients, and the regular subscription fees still would apply. We do not bill any third-party insurers, including Medicare. We still are able to send you to specialists and order labs and procedures.
Federal and state legislatures recognize the need for changes in policy to help the DPC model grow and thrive. New programs that would allow Medicare beneficiaries to participate in DPC using their government benefits are being tested nationally. Hopefully, we will soon have a plan for these programs.
• DO YOU RESTRICT SUBSCRIPTIONS BASED ON PREEXISTING CONDITIONS?
• IS THE REGISTRATION FEE A ONE-TIME FEE?
The aged-based or family plan monthly subscription fee covers all of your primary health care needs at our office. We charge a non-refundable registration fee of $95 per patient in addition to the first month subscription. There is a maximum of $285 in registration fees for enrolling a family of three or more. Should your membership lapse or be terminated, the registration fee plus 3 months subscription must be paid in advance for membership to become active again.
• IS THERE A SPECIFIC TIME FOR ENROLLMENT IN ON POINT PRIMARY CARE?
• WHAT IF I CANCEL MY SUBSCRIPTION?
You can cancel at any time. If you decide to cancel and have prepaid subscription fees, you will receive a refund for the remaining portion of the fee that you have paid for or will be provided coverage until the next billing cycle. To cancel, submit a written notification. Cancellation of services is effective on the date we receive the letter or at a later date if specified. The registration fees are paid up front and are non-refundable.
• WHAT SERVICES ARE PROVIDED AND HOW MUCH DOES THIS COST?
The subscription covers all office visits. There is no co-pay when you come in for an office visit. The only time you will pay a fee is if we provide and/or order a service not listed. We will always discuss any cost that would not be included. We think you will be pleased and surprised at all that is covered. (Services and Pricing)
• HOW DO I DETERMINE IF this is right for me?
• ARE YOU A WALK-IN CLINIC?
NO! Our intent is to be able to offer same-day or next-day appointments for our subscribers with as short a wait and as unhurried a visit as possible. So, please contact us first to make an appointment.
* DO YOU PerFORM SCHOOL AND SPORTS PHYSICALS?
Yes! We are happy to offer school and sports physicals and complete any required forms. Please bring the forms to your scheduled appointment. Some forms require specific labs, screens, or sign-off, so we'll need to see them at the time of your exam.
• IS THE SUBSCRIPTION FEE TAX-DEDUCTIBLE?
We are not tax experts but we've been advised that your subscription fees are not yet considered a “medical expense” in most states and, as such, are not deductible, even though the fees cover medical care provided by a qualified physician. Groups are lobbying hard to win rightful deductibility for these expenses. When passed by Congress and signed by the President, the Primary Care Enhancement Act of 2015 will become law and make DPC fees tax deductible. In the meantime, speak with your tax consultant to clarify tax consequences in your situation.
• WHEN YOU GET BUSY, WILL YOU HAVE THE SAME TIME TO COMMIT to your PATIENTS?
We will “cap” the number of patients under a doctor's care to between 600–800. In contrast, doctors in insurance-based primary care practices care for 1800–3000 patients! Smaller patient loads allow us to provide better accessibility, availability, and quality care.
• Where are you located?
Our address is 2037 Jerry Murphy Rd., Suite 200. We are located on the South-West corner of Jerry Murphy Rd. and Monetbello. Entrance options are on the West parking area or East entrance. There is a ramp for wheelchair use located on the East entrance.
For a map, see https://goo.gl/maps/sroQtkaf7xC2
• Do you carry prescription medication in your office?
Yes! We stock medication according to our patients' needs. We have a few basic acute medications like antibiotics or anti-fungal agents that are cost-effective and convenient. We don't want you to stand in line for 2 hours at your pharmacy waiting for a medication when you don't feel well. We also can provide inexpensive generic medications for chronic conditions like hypertension, diabetes, and cholesterol. Please bring your medications and we'll see how much we can help you save!
AT NO TIME WILL WE EVER KEEP CONTROLLED MEDICATIONS IN OUR OFFICE.
**We will collect payment information from you, but you will not be charged until we confirm your subscription in person or by phone.