FAQ


 

Direct Primary Care

What is Direct Primary Care?

Direct Primary Care, or DPC, is a model of healthcare that puts patients first by getting rid of the red tape that constrains traditional practices. How? It's simple: we don't accept insurance, and – believe it or not – this actually saves most everyone money in the long run.

How will this save me money?

You will have substantially reduced costs as compared with current fee-for-service models and every dollar goes towards your care, not to service a bloated annual deductible. The negotiated savings on laboratory testing and some prescription pharmaceuticals as well as many common imaging studies often save patients hundreds of dollars annually. Also you may be able to avoid some visits altogether because of advanced access to your personal physician. Send your questions directly to us via email and text – something you can't get in traditional practice models. If we had contracts with insurance companies, we would be legally obligated to charge higher prices.

 More importantly, since you are getting all this amazing care from us, you can cut way back on your insurance premiums. Most DPC patients find a high-deductible, lower-premium insurance plan so they're covered in the case of a major health issue. But leave the rest of your healthcare to us.

Will I benefit from direct primary care if I don’t require frequent medical attention?

Of course. Everyone benefits from a service tailored directly to them. That’s why we offer truly custom healthcare. We’re here for you if you're sick or hurt, but we also help you proactively maintain good overall health. Visits with us will be thorough, relaxed, and as long as you need to address your health concerns. The longer you're our patient, the more we learn about your health and lifestyle, and the better we can help you maintain that health.

Is this the same as concierge medicine?

The terms are often mistakenly used interchangeably, but they are not the same. Both DPC and concierge practices charge a periodic retainer fee, however, under the concierge model, this fee only gets you access; that is, it doesn't actually cover any of your care. Instead a concierge practice still bills insurance for your visits. Under DPC, your visits and other care are included in your fee, plus you're provided with other incredible benefits like near wholesale pricing for labs and radiology studies, deeply discounted prescription prices, direct digital communication with your doctor, and all the rest.

Want to know more about Direct Primary Care?

Here’s a few articles that profile the Direct Primary Care approach to medicine:

FORBES: Direct Primary Care: Restoring The Doctor-Patient Relationship
TIME Medicine is About to Get Personal
US News Physicians Abandon Insurance for Blue Collar Model
AARP The Doctor Will See You But Not Your Insurance
American Academy of Family Physicians Direct Primary Care
WRAL Patients Pay Monthly Fee, Not Insurance Co-Pay to See Raleigh Physician

Membership Questions

So how much does membership cost?

See our prices on our pricing page. We charge a flat monthly fee, and in exchange you get an annual health evaluation, other needed office visits, near wholesale prices on prescription medication, your doctor's cell phone number, and a whole lot more.

What does the membership fee cover?

The fee covers excellent primary care. This includes the following: annual wellness exams, sports physicals, school physicals, chronic care office visits, follow-up visits, basic office procedures and treatment of acute illness or minor injuries, all with minimal wait times in the office. The fee also covers direct communications with your doctor: phone, text, video chat or email.

Our patients will also have access to discounted labs, prescriptions and special procedures not included in the membership fees.

What medical conditions do you care for?

We treat all kinds of common everyday problems like colds, flu, strep, rashes and injuries. We also treat more complicated long term medical problems like diabetes, high blood pressure, high cholesterol, thyroid disorder and much more.

What happens if I need to go to the hospital or see a specialist?

For starters, having such unprecedented direct access to your doctor may very well serve to prevent many hospitalizations and avoid the need for specialty referrals in some cases. However when higher acuity levels of care are required, we will work closely with the hospitals and all attending providers during your hospitalization to help insure they have a thorough understanding of your health history and then help transition back home when you're able - we are the ultimate patient advocate and care coordinator. Depending on the level of care and the specific expertise required, we may have to rely on specialized caregivers to help manage some of your ongoing treatment. Regardless of your circumstances, we are committed to pursuing care pathways that are in your best interest.

Can children become members too?

Yes. We are happy to accept the children. See our pricing page for details.

Can I contact my physician after hours?

Of course! Physician access is one of the greatest benefits of the direct primary care model. Because illness and injury do not respect regular office hours, you may call, text, or email your physician whenever you need.

What if I need medical attention while I’m away from home?

Of course – this sort of care is "baked in" to the DPC model. Because you'll have your doctor's email and phone number, you can reach out to us whenever you need, wherever you are. Many illnesses can be diagnosed and treated with a simple conversation. We’ll also work with you to locate the nearest pharmacy and order any medications that may be appropriate for your circumstances.

Are my medical records ever shared with government agencies, insurance carriers, or pharmaceutical companies?

We maintain high standards of patient privacy. We will never provide your health information to any third party unless you specifically ask/legally consent that we do so.

When do I pay my fees for non-covered labs and procedures?

Charges will be added and applied to your preferred method of payment at the time services are rendered.

What if I decide to cancel?

We expect to have an open, honest, respectful relationship with you. If you have voiced a complaint that we cannot satisfy together, we will gladly allow you to terminate your membership. Please refer to the "Membership Agreement" for full details.

Insurance

Do you accept insurance?

No, fortunately for both you and us. Perhaps the most critical distinction in our model of care centers on a direct, personal relationship between you and your doctor. That directness carries over to our business model as well. You might use your auto insurance to fix a smashed fender or other major damages. But you'd never use it to get an oil change (or pay for gas!). For some reason, health insurance is currently being used for the equivalent of oil changes for humans - routine physicals, office visits, simple blood tests, and minor procedures. This just doesn't make sense.

We forgo insurance payments in order to save our patients from the arbitrary, intrusive decisions that come with using insurance. Charging a direct monthly fee frees us from the typical contractual agreements that prevent non-DPC physicians from offering wholesale prices on laboratory tests, imaging, and medications.

I don't have insurance - can I still join?

Yes, we take care of any patient regardless of your insurance situation. Since we work completely outside of the insurance system, none of the billing for care here is eligible for insurance reimbursement. However, we recommend that everyone have insurance coverage, which is still important in the event of a major health issue.

As a patient, will I still need health insurance?

Yes. We recommend our patients continue a major medical plan with a high-deductible and health savings account. If you experience a major health issue, you will still need insurance to help cover it. We’re happy to refer you to insurance representatives who can help customize an insurance plan to your specific needs.

If I have Medicare, can I still join?

I will continue seeing patient's who have Medicare, but because of policies and mandates by the Center for Medicare and Medicaid Services (CMS), you will not be eligible for any of the special benefits of membership (discounted lab, imaging and pharmaceutical costs,...). Your Medicare benefits will otherwise remain unchanged and can continue to be used for all other medical care received outside of our practice. Medicare will still cover their portion of any laboratory testing, imaging, medications, or hospitalizations prescribed by our offices through local laboratories, imaging facilities, pharmacies, etc.

How does DPC work with Obamacare?

As the Affordable Care Act was being drawn up, several doctors worked very diligently to insert into the health reform bill a clause that allows for Direct Primary Care practices like ours to be a legal and approved option under the health reform bill. However, being in a member of a DPC practice does not satisfy the individual mandate required by this legislation.

In short, the best option for many patients will be an “exchange qualified” major medical type plan combined with a Direct Primary Care provider like our practice. This combination will save the maximum amount of money, while also allowing for a maximum amount of health care for patients.

The Direct Primary Care practices have the ability to decrease the cost of insurance by 30-50%, thus eliminating the need for ObamaCare-style regulation because we can make health insurance affordable again.

Is the membership fee eligible for HSA or FSA reimbursement?

You may want to check with your human resources department regarding the use of Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) as possible payment options for our services. If you are unable to use these funds to pay for the membership fee directly, there is a good chance that you can still use your HSA/FSA as reimbursement for the Comprehensive Health Maintenance Evaluation (which includes a 1-year membership) as well as some of the other services provided through our office.

Is my membership fee tax deductible?

Unfortunately, no. Your retainer is not yet defined as a "medical expense" in most states and as such is not deductible. Please confer with your tax consultant to clarify tax consequences in your particular circumstances.

Location
Integrated Care
22285 N. Pepper Road, Suite 407
Lake Barrington, IL 60010
Phone: 847-387-3934
Fax: 847-852-3430
Office Hours

Get in touch

847-387-3934