FAQ - Direct Primary Care: Coming Soon!
Does Direct Primary Care take insurance?
It doesn’t. Instead it allows us to work directly with you, rather than work for your insurance company. The for-profit insurance industry has put lots of layers between people and their doctors, which leaves less time for visits and has industrialized our industry. As far as doctors go, this has made us feel rushed, overwhelmed and pulled in too many directions when we would rather be working with you to improve your health. By not working directly with insurance, we are able to:
• Keep costs much lower
• Spend more time with you
• Be available to you in many more ways like - messaging, email, phone, telemedicine, group visits and home visits. These are all included with Direct Primary Care. There will be many times where we can deal with an issue by messaging or phone that we can’t afford to do with insurance coverage plans.
What about Medicare?
We do not bill Medicare in our Direct Primary Care practice. We do, however bill Medicare if you are part of our traditional practice. Medicare simply doesn’t acknowledge or pay for many of the unique and helpful services we offer in the Direct Primary Care side of our practice so we opt out of billing them. If you are currently enrolled with Medicare and want to switch to Direct Primary Care to save money or for the unique services it offers you will be asked to sign a form at or before your first visit that shows you understand we will not bill Medicare for any of our Direct Primary Care practice visits or services and that you agree to not bill Medicare for any of our services. Your Medicare may still be billed for any and all services outside our Direct Primary Care practice, including but not limited to labs, radiology, specialist visits, and hospital care. Being a part of our Direct Primary Care practice doesn't impact your ability to use Medicare for everything else! Which side of our practice you choose is up to you.
Do I need health insurance to become your patient?
We recommend everyone have some form of health insurance, but health insurance is not required simply to be a member of our Direct Primary Care practice. Health insurance helps pay for things that happen outside of our clinic. Most individuals or families will want to have a high deductible plan that covers catastrophic events. Our affordable membership is designed to cover your basic primary care needs for a predictable, transparent monthly price.
I already have health insurance. Why would I pay for this?
Excellent question. Health insurance doesn't guarantee you access to a doctor, to quality care or to the type of care you want. What we offer is a reliable, continuous partnership with patients with a staff and providers who really know you. In Direct Primary Care we offer the ability to communicate directly and in a timely manner. We will reserve same day, priority visits for Direct Primary Care members. Ultimately this model can save a lot of money for the individual and the system. It offers better access and better care. The model may not be for everyone, but many are finding it ideal for their medical care.
Can my HSA/FSA dollars be used towards the
monthly membership fee?
Current laws state that HSA dollars cannot be used for your Direct Primary Care membership fee, but can be used for all other medical care you receive, including labs, radiology, hospital care, specialty visits, etc. FSAs may be used depending on the employer's FSA criteria, so check directly with your employer or plan administrator especially if you’re a part of our Direct Primary Care for local businesses. The laws may change in the future.
But I only go to the doctor once a year! I pay for you every month whether I see you or not?
You're paying for access whether you use our clinic once yearly or weekly for chronic needs. By design this model is meant to be used collaboratively to improve your health. Your monthly cost is a great investment in your health and helps to sustain us as a practice to continue to deliver care to the thousands in our community. For your monthly fee you receive unlimited clinic visits (typically whenever you need them), home visits (when appropriate), messaging through your secure electronic medical record, and phone calls. We cannot guarantee or offer those types of services in our traditional practice, but in Direct Primare Care it’s built in. In addition many will save large sums on their monthly medication costs due to our low cost refill option offered only in the Direct Primary Care option.
Some people would rather pay for each visit rather than pay on a monthly basis. We offer a "Fee For Service" option which allows you to enroll as a patient and pay based on time for all visits, email visits, and phone visits. Here are our "fee for service" costs, which are a fraction of what most clinics bill to insurance for their visits:
- 15 minute visit: $75
- 30 minute visit: $150
- 45 minute visit: $200
If I get really sick will my fees go up?
No. Our fees cover your costs for one full year. They may be subject to increases but patients will be notified in advance.
Is this a "concierge" or "boutique" medicine
No. Concierge Medicine charges very high fees for ACCESS but still bills insurance. We have two wings of our practice - a traditional side and our Direct Primary Care side, the latter is designed to offer afforable access.
Do you provide vaccines in your clinic?
Vaccines are offered on our traditional side and Direct Primary Care side. Insurance can be billed on either side and there are special situations (pediatric vaccines provided by the state). Your vaccine needs will still be provided regardless of which wing of our practice you choose.
Am I required to join the Direct Primary Care membership to get healthcare at Eventide?
No. We offer both wings of our practice to let you choose what’s best for you. Some will choose traditional Medicare or insurance model and we will continue to offer that. Some however, will choose the Direct Primary Care model due to the incredible options - access to your provider via electronic methods, online access to labs, very low cost meds, extended/unlimited visits, phone call visits, etc.
What's not covered in the Direct Primary Care option?
Any service that happens outside our clinic is not included - imaging, specialists visits, hospitalizations, physical therapy, etc.
What happens if I get admitted to the hospital?
Your hospital stay will be billed to your insurance or Medicare just as it would normally. You’ll still get follow up care here in our clinic via Direct Primary Care visits. All of the current data show that patients in Direct Primary Care practices have fewer hospitalizations.
What happens if I travel or live somewhere else part of the year?
You can still access our Direct Primary Care option even if you travel or live anywhere else in the world for part of the year. Our visits will take place via telemedicine, phone or direct messaging.
What if I want to cancel my membership or change practices?
You may cancel your membership at any time. You are welcome to stay in the traditional side of our practice if you find that the Direct Primary Care option isn’t a good fit for your needs. To re-join the Direct Primary Care practice at the monthly membership rate after leaving there is a $300 re-enrollment fee.
Also, for those who wish to leave the practice and want their records sent to another practice, there is a $25 processing fee.
Let us help you design better healthcare today with Direct Primary Care.
689 Airport Center Drive
Friday Harbor, Washington 98250