Why Direct Primary Care

Direct Primary Care

Common Questions Answered

Primary Care is “covered” by my mainstream insurance, so, why would I also pay my primary care doctor directly?

Dr. Norman believes Primary Care should be affordable, accessible, and patient-centered. In her 10 years of practicing Primary Care, she found an ever-widening gap between the costs of basic services, and what insurance companies actually cover.

At Grace Health, you will not be penalized for bringing up medical questions and concerns during your annual physical. You will not spend hours on hold, trying to reach your primary care physician, only to be scheduled with a provider you’ve never met, and have to repeat your story all over again.

As a patient of Grace Health, you will have direct access to YOUR doctor, who you will see every single visit. You will have access to discounts on lab work, medications, and imaging studies, and Dr. Norman will use her industry knowledge to help find affordable ways of connecting you with the care you need.

Affordable, personalized, patient-centered. The way Primary Care should be.

What about services that my mainstream insurance DOES cover?

Dr. Norman strongly encourages her patients to have insurance, to cover unexpected events, specialist care, and emergency department and hospital costs. As a Board Certified Family Medicine physician, Dr. Norman orders insurance-covered services such as colonoscopies, mammograms, routine labs, imaging and pap smears. Except in rare cases, the cost to you is the same as seeing a primary care physician who bills insurance for their visits. You may find, however, that Dr. Norman’s negotiated rates on labwork, imaging, and medications, are even more affordable than going through insurance!

Is Direct Primary Care insurance?

Direct Primary Care is not insurance. Dr. Norman recommends that each of her patients carry insurance, or have a plan for covering unexpected expenses such as specialist co-pays, emergency department visits, and hospitalizations.

Is Direct Primary Care a type of Concierge Medicine?

Grace Health keeps our costs low, by avoiding unnecessary expenses involved in working with insurance companies. Because most Concierge practices bill insurance, they require higher overhead for billers, coders, pre-authorization specialists, etc. They, in turn, pass these costs on to their patients.
Direct Primary Care is an affordable, patient-centered approach that cuts out the middle man, and saves you money.

How is Direct Primary Care Different?

Most primary care in the United States is “fee-for-service.” Doctors at these clinics are financially rewarded for shorter, more frequent visits. Anything not labeled “preventative” is paid for by you and your insurance, through a confusing system of deductibles, copays, coinsurance, and facility fees. You may or may not get to know your doctor personally, because they have panels of 1,500 patients or more. You pay high retail rates for imaging, labs, and medications.

Direct Primary Care gives you direct access to your physician right away, no deductible, no surprises. You always see YOUR doctor, not their office partner. They know you personally, because they have <500 patients. You get significant discounts on imaging, labs, and medications. Just one low monthly fee, less than a typical cell phone bill.

Direct Primary Care

Fee-For-Service

Why DPC?

Cost

$60-$100 per month

$100-$250 per visit (subject to deductible, copay, coinsurance)

You know your costs up front. There’s no charge to seeing your doctor more often if you want to. Visits are usually 30-60 minutes, so you have time to talk about what you need to. You can also connect with your doctor over phone/email/text if you prefer. You’re in control.

Access

Cell phone, text, email or televisit directly with your physician. Visits within 24 hours most of the time.

Phone tree to reach your doctor’s nurse. You might see their physician assistant today, if they can get you in. Otherwise, your doctor is booking several weeks out.

Call, text, and email your doctor directly! You see YOUR doctor, every time. There’s no charge for asking additional questions, as they come up. Visits can be as long as they need to be, at times convenient for you.

Privacy

Your medical information is kept within the practice, accessible only to your physician and their immediate staff.

Your medical information is entered into an electronic medical record that may be accessible to hundreds of other offices within a hospital-affiliated medical system.

Your information remains within the clinic unless you specifically request it be shared.

Labwork, imaging, and medications

Substantial savings through negotiated pricing, industry discounts

Beholden to insurance company pricing

Fee-for-service practices work primarily through insurance companies, which limits their ability to negotiate directly with imaging centers, labs, and medication wholesalers. DPC physicians don’t sign these contracts, which leaves them free to negotiate substantial discounts directly, and pass these savings on to their clients.

Society economic benefits

Decreases emergency room use, unnecessary hospitalization, and medical bankruptcy through timely, affordable, accessible care.

It’s better than not having a primary care doctor, even if it’s expensive.

Data shows that membership in DPC practices help avoid unnecessary emergency room visits, avoidable hospitalizations, and saves patients and employers significant unnecessary costs.

Benefits to employers

Lower cost to employers. Immediate access for employees. Better health, fewer sick days, better retention.

It’s better than not having a primary care doctor, even if it’s expensive.

Because the majority of routine healthcare needs can be addressed by a primary care physician, DPC reduces barriers to timely care, with the potential to lessen out-of-work time, and improve retention.

Preventative Care

Your yearly physical is covered by membership.

Your yearly physical is covered, but if you have questions about anything else (your diabetes, a medication change, an urgent concern), you may be billed for a separate visit.

Bring up whatever you want at your yearly DPC physical. It’s covered! Your un-rushed, hour-long visit allows time for questions and concerns (in addition to your pap smear and other preventative care).

Diabetes Care

Your checkups are covered by membership. Your medications might be a lot less expensive. Example prices (as of 08/01/2020):
Metformin $3/180 tabs
Lantus Solostar Pen $70/pen

Each visit is $100-$200, paid by you or, if you’re lucky, partly by your insurance. You have to keep track of deductibles, copays, coinsurance. You pay retail rates for all medications, and need to keep track of which ones your insurance prefers (which may or may not be the ones that work best for you).
Average retail prices:
Metformin $10/180 tabs
Lantus Solostar Pen $100/pen

Direct Primary Care puts the patient back in the driver's seat. Your DPC doctor is your ally, an active and engaged partner. The way it should be.

Sports Injuries

Direct Primary Care physicians can negotiate substantial savings on imaging, splints, and other treatments for acute or chronic sports injuries. For example:
Plain film x-ray including radiologist reading: $50
Basic wrist splint: $10

Fee-for-service doctors generally don't even know the costs of the imaging and splints they order for you, and those provided by the hospital system that employs them are often at inflated costs.
Plain film x-ray with radiologist reading: $200-300
Basic wrist splint: $50-$100

Unlike most doctors you may have worked with, Direct Primary Care physicians make a point of educating themselves about the costs of the care they provide. Whenever possible, they leverage their physician buying power to keep costs down for their patients.

Procedures

Your DPC doctor can offer routine office procedures at affordable prices to help you avoid unnecessary expenses. At Grace Health, procedures are available to Members for a flat fee of $30.

Typical prices billed to insurance, at a fee-for-service clinic (based on average CPT code reimbursement as of 2020):
Skin tag removal: $115
Subacromial bursal (shoulder) injection: $150
Wart cryotherapy: $125
Mole removal: $200

Direct Primary Care doctors help make routine office procedures accessible to their patients, regardless of insurance status or deductible/copay/coinsurance. Our prices are transparent, so you can make informed decisions that fit within your budget.

Why Direct Primary Care

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