FAQs about Direct Primary Care
Typical questions about how direct primary care works
Direct Primary Care (DPC) is a healthcare model where patients pay their primary care provider directly through a membership or subscription fee, bypassing traditional insurance billing.
This model allows for a more personalized and accessible experience, with benefits like longer appointment times, more direct communication, and reduced administrative overhead. Patients pay a fixed monthly fee, which covers most primary care services, helping to eliminate co-pays and deductibles while providing predictable costs and a focus on preventive and comprehensive care.
- Greater access: In traditional primary care, patients often delay addressing medical questions and health concerns due to the challenges and costs associated with scheduling a doctor’s visit. This can result in less effective healthcare overall. With no additional fees for doctor visits, you are more likely to seek care promptly, ask more questions, schedule follow-up appointments, and focus on preventive care.
- More Flexible Access: Pay-per-visit models often require patients to come into the office for every issue, limiting convenience. With a membership, you gain more flexible access to your doctor, whether through texting, telemedicine visits from home, or getting care while on vacation. This increased accessibility promotes better overall health.
- Impartial advice: the direct primary care model frees doctors from the constraints of insurance, allowing us to provide truly patient-centered care. In traditional healthcare, advice can often be influenced by what insurance will cover, which limits treatment options. In our model, you receive unbiased advice tailored to your unique needs without the restrictions imposed by insurance, allowing you to decide with price transparency how to best care for yourself. This approach fosters deeper doctor-patient relationships and empowers us to focus on delivering the best possible care.
In the Direct Primary Care model, our doctors do not bill insurance for their services, and the membership fee is not covered by insurance.
This is a key factor in making DPC work effectively. By removing insurance from routine healthcare, we can lower costs, spend more time with patients, and focus on providing personalized care that truly benefits you.
We strongly recommend maintaining your insurance and you can still use it for things like lab work, referrals, and imaging. However, many patients find that paying out-of-pocket, non-insurance cash prices for these services is more affordable than using their insurance.
For those who rarely meet their insurance deductible, our DPC model can save you money by reducing out-of-pocket expenses. While insurance is valuable for protecting against major medical expenses, we recommend using it for significant health events—similar to how you wouldn’t use car insurance for routine maintenance like an oil change.
As a member of Four Mile Creek Health, you have unrestricted access to your personal physician. Whether you have a quick question or need a more detailed visit, there are no additional charges for services provided by the physician.
Furthermore, members are able to take advantage of on-site testing services, whole-sale priced medications, and negotiated rates for off-site testing and imagining.
A Seca Body Composition Analyzer is free to all members (Seca Body Composition Testing). This device can help with monitoring progress and helping get the most out of your primary care.
Four Mile Creek Health is dedicated to following the direct primary care mantra of full price transparency. Prior to any service or transaction that you are not using insurance for, the physician will go over the costs.
The costs will only be the wholesale costs of the medications dispensed or the materials used in any testing.
Because there are no additional costs imparted to the patient for these medications, products, or materials, members of Four Mile Creek Health can rest assured there are no incentives to prescribing unnecessary testing or services. The health of our patients is paramount and is the one and only priority in our minds.
It is very important to us that you feel comfortable working with us. The best outcomes occur when patients and doctors have open and honest communication. That being said, the best way to determine rapport is by contacting us and having a 15 minute conversation about your goals and how we can help you accomplish those goals.
Contact UsThough we would be sad to see you go, membership voluntary and you are free to cancel your membership at any time. Please try to give us 30 days notice to close out your account. For monthly memberships, we will just stop payments. For semi-annual and annual memberships, we will refund the prorated amount as soon as possible.
FAQs about Four Mile Creek Health Membership
Typical questions about how membership with Four Mile Creek Health
FAQs about using Medicaid or Medicare
Typical questions about how direct primary care works
Unfortunately, no. At this time, it is illegal to charge patients out of pocket fees for covered primary care services.
Yes, we do take Medicare patients; however, there are many limitations to the care that can be provided.
At our direct primary care clinic, we strive to provide clear and transparent healthcare. Your monthly subscription fee is designed for services beyond what traditional Medicare covers, but cannot be used for services that Medicare does cover. This includes:
- cutting-edge health interventions like longevity-focused treatments, senolytics, and lifestyle medicine designed to optimize your overall well-being
- advanced cancer screening options such as cell-free DNA testing
- tools like the InBody scanner for comprehensive metabolic health assessments
- personalized nutrition advice
- weight loss medications
- continuous glucose monitoring (CGM) prescriptions
This approach ensures you receive a more proactive and holistic level of care tailored to your specific health needs.
Yes.
While a DPC membership offers enhanced and specialized care, it’s important to maintain a relationship with a primary care physician who is covered by Medicare. Regular check-ins, at least once a year, with your Medicare provider ensure that you’re receiving routine services and screenings that are covered under your plan, such as annual wellness visits, vaccinations, and other preventive measures. This dual approach allows you to benefit from both the comprehensive care provided by your DPC membership and the essential services covered by Medicare, ensuring a well-rounded and cost-effective approach to your healthcare.
Because of specific rules regarding government-provided insurance.
Medicare has specific rules about how services are paid for. If you’re covered by government insurance of any kind, it usually doesn’t allow you to pay out of pocket for services that your insurance is designed to cover. This is because the government wants to ensure that you use your benefits, and doctors who work with Medicare have to follow these rules.
Medicare operates as a fee-for-service system, where providers bill the government for services rendered to beneficiaries. DPC, on the other hand, is based on a subscription model where patients pay a monthly or annual fee directly to the physician for primary care services.
The federal government prohibits Medicare providers from accepting payment outside the Medicare system for services covered by Medicare. If a doctor wants to provide services to a Medicare patient under a DPC model, they must formally “opt out” of Medicare. This means that they can’t bill Medicare for any services for a period of two years and must have all patients sign an agreement acknowledging that Medicare won’t cover any services provided by that doctor.
This regulation creates barriers for DPC doctors who might otherwise want to care for Medicare patients because opting out of Medicare is a complex process, and they would be unable to receive any Medicare reimbursement during the opt-out period. As a result, many DPC doctors choose not to work with Medicare patients to avoid these complications.
Yes
Labs and imaging ordered by Direct Primary Care (DPC) doctors are not subject to the same restrictions as direct primary care services themselves when it comes to Medicare patients. While DPC doctors may not bill Medicare for their services if they have opted out, labs and imaging tests are typically handled differently.
Here’s how it works:
- Labs and Imaging Providers: When a DPC doctor orders labs or imaging, the patient can go to a third-party provider (such as a lab or imaging center) to have these services performed. These providers can bill Medicare directly for the services, assuming they participate in Medicare, even if the ordering doctor is a DPC physician.
- Billing: As long as the lab or imaging center is a Medicare-participating provider, they can submit the claims to Medicare for reimbursement, regardless of the DPC doctor’s relationship with Medicare.
- Out-of-Pocket Costs: The patient may still have co-pays, deductibles, or other out-of-pocket costs as determined by Medicare rules, but the services themselves are generally covered by Medicare as long as they are medically necessary.
Yes, we would be more than happy to discuss your concerns and see if Four Mile Creek Health would be a good fit for you.
We would suggest a 15 minute phone consultation at your convenience. Please contact us at info@fourmilecreekhealth.com
