Q: What is Direct Primary Care?

Direct Primary Care is a patient-focused approach to health care where the doctor and patient contract directly together and eliminate the restrictions and inefficiencies of the insurance “middleman.”

It affords greater access and more personalized care, allowing you to discuss your unique healthcare needs and goals without long waits, rushed appointments or third party intervention.

Q. What are the benefits of a membership?

  • Flexible access to your doctor via cell phone, text message, email and even video conferencing (e.g. Skype) Same or next day office visits with little to no wait time
  • Personalized comprehensive annual physicals
  • Wellness coaching (including nutritional guidance)
  • Coordination of care across specialists
  • Unrushed appointments (you are the priority)
  • Time to focus on preventative healthcare and you as a total person

Q: Can I bill my insurance or Medicare?

No, Insurance/Medicare does not pay for the annual membership fee in a direct primary care practice. However, it does not conflict with your existing insurance coverage.  You can still use your insurance for items such as surgical procedures, medical equipment, specialists, hospitalizations, etc.  Coverage is important for expensive, unforeseen events. But, coverage is not an effective way to pay for the quality everyday care that supports our health.  Ask yourself: “Would I use my automobile coverage policy to keep my car in good condition…?”

 

Q: Why don’t you take Insurance or Medicare?

There are 3 reasons IdealMD affiliated doctors do not accept insurance:

1. Doctors want to be available to their patients  

  • The insurance system is driven by volume, not value.  Doctors being paid by insurance must see an unreasonable number of patients (3,000 + patients on average), which means longer wait times and rushed appointments.
  • IdealMD affiliated doctors don’t deal with the red tape of insurance billing.  By freeing themselves of this burden, affiliated doctors have the time to delve into your health, not just treat symptoms.

2. Doctors don’t want insurance dictating how they care for their patients

The insurance system (by design) must fit every type of visit into a billing code; thus the doctor must tailor your visit to correspond with these codes in order to get insurance company approval and get paid.  This is why you and your doctor are confined to talking about a single issue per “visit type”. Isn’t this crazy when you think about it…?

  • IdealMD affiliated doctors are not working for the insurance companies. You are their customer, so your doctor will have the freedom to focus on your care — not what fits an insurance billing code.

3. Doctors want to focus their time on Care – not Insurance Billing

In the insurance system, doctors spend half of their time on insurance billing and insurance related issues.

  • IdealMD affiliated doctors spend no time on insurance billing. Instead, they focus on helping you optimize your health.

Q: Do I still need Insurance?

Yes. It is important not to confuse “coverage” with “care”. Insurance is important to cover you for expensive, unforeseen events.

In the same way you maintain home or automobile insurance, health insurance is needed for events such as surgical procedures, hospitalizations, specialists and certain lab/diagnostic tests or specialty medications (although we can help you beat insurance prices on many tests and medications through our consumer advisory service).

Q: How do I justify paying separately for my primary care?

First, don’t think you’re paying twice.

The highly limited primary care offering through the insurance system (which often leaves people using expensive, hit or miss urgent care instead) is a totally different offering versus what you will receive with a direct primary care doctor.

Consider this: Do you use your auto insurance for oil changes or routine maintenance?  Or do you use your homeowner’s policy to keep your house clean?  If you did, imagine how expensive your auto or homeowner’s insurance policies would cost. This is what has happened to health insurance.

Think about it:  every time you go to the doctor there is a copay.  So your initial visit is $40 (average copay), the follow up visit is $40 and if you have to get a prescription, your prescription refill visit is $40–this on top your monthly insurance premiums. It gets expensive. Direct primary care eliminates copays and saves you money.

If one truly considers the total cost of insurance co-pays, monthly premiums, deductibles etc., a membership in a direct primary care practice is often quite affordable–Not to mention how much is your time worth.

It is also important to note that studies have shown that direct primary care greatly reduces unnecessary testing, hospitalizations, ER visits, and specialist visits; thus saving more money and supporting better health outcomes.

Q: What is the cost of your plan?

Direct Primary Care is surprisingly affordable. The cost is usually less than the average cable bill or cell phone plan.   By eliminating the red tape and inefficiencies of the insurance system, direct primary care practices can offer affordable rates to their members. Membership varies for each physician so please call for more information for about each individual practice.

Q. Is there a discount for families?

Yes, but please note practices may vary in the minimum age of children.  Some doctors will see children of any age, while others see children 10 years old or older.  Please call for more information to find the doctor right for you and your family.

Q. I would like to meet with the doctor to discuss whether this practice is right for me. Is that possible?

Yes. You can schedule a meeting with one of our physicians to discuss the benefits of their direct primary care medical practice. Please call for details.

Q: How do I pay?

Your membership may be paid via check, bank draft or major credit card; and can be paid monthly, quarterly, semiannually or annually (membership discounted for paying annually).

Q. What about lab or X-ray fees?

Although these fees are not covered by your membership, some practices do offer a full spectrum of medical services, including many common in-office procedures (i.e. blood draw, etc.) at a greatly reduced cost.  Please call for details.

For advanced diagnostic testing procedures not available in office, our personal advisory service will help you get the best pricing for these types of services available within your insurance coverage or direct pay.

Q. What if I need a Specialist?

Our doctors will refer you to the appropriate specialist and will be your health advocate during the process.  Your membership includes a personal advisory service that will help you get the best pricing for these types of services available within your insurance coverage or direct pay.

Q. What if I am admitted to the Hospital?

If you are admitted to a hospital, you will be assigned a Hospitalist during your stay.  This doctor is employed by the hospital and is tasked with overseeing patient’s care within the hospital during their stay at the facility.

However, the Hospitalist does not conflict with, or replace the relationship you have with your primary physician.  In fact, communication between the hospitalist and your primary physician, who knows you well and your history, is another benefit of membership.

Our affiliated doctors have the time to follow up with you and communicate with the Hospitalist, Specialists, etc.  Having a doctor that personally knows you and can be available to help you translate the information and options during these times can be invaluable.

Q. Are prescriptions covered in the membership?

Medications are the patient’s’ responsibility.  Your membership includes a personal advisory support team to help you shop for the best price for medications either within your insurance plan, or direct pay to help you save money and stress.

Q. Can the doctor write me a prescription if needed?

Yes.  Your doctor is board certified and fully licensed to practice in their appropriate state.

 

Q: Do you have a Doctor in my area?

We are adding doctors all the time. Please call to check availability in your area.

Q: Do I have to sign a Long-term contract?

No.  The membership agreement is only a one-year term.

Q. What is IdealMD’s role?

IdealMD is a membership services company that helps doctors and patients connect for direct relationships.  Our services allow the doctor to focus their time on caring for you.

IdealMD is not a physician or physician group, and does not provide any medical services.  Your physician/practice will use its independent professional medical judgement to determine and deliver all medical services provided by the practice to you.

 

For Patients Please fill out the form below to learn the benefits of Direct Primary Care from a doctor near you.
For Physicians To learn more about becoming a Direct Care Practitioner who is able to spend more time with your patients while building a sustainable practice, please fill out the form below.

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