Common Questions in Direct Primary Care:  Insurance, Medicare, and Other Topics

What is Direct Primary Care?

• Direct Primary Care is a nation-wide movement of Primary Care doctors who have disembarked from the insurance companies and their assembly-line model of medicine in favor of re-establishing the patient-doctor relationship.  It is a form of concierge medicine that is designed to be affordable for the masses.  We operate on a monthly membership fee, much like a gym, which allows patients to receive office visits and technology visits (email or text messages). 

Why is a Direct Primary Care practice a better option? 

• Many patients today and in the near future will end up having high deductible plans, where the insurance won’t cover the first $2,000-$5,000 that they spend anyway, but with our membership model, they can maximize the amount of healthcare they get and minimize their cost.  In the new model of care, we work with our patients directly through a monthly membership so they get unlimited office visits and what we call technology visits. They also don’t have co-pays for anything in our office.  Any procedures we can do in our office like:  EKG, PFT’s, biopsies, cryosurgery, joint injections, osteopathic manual treatments (OMT), etc., are included free of charge. 
• In addition, we will run our own pharmacy out of the office, so we can get medications at wholesale pricing.  We can also get labs at wholesale pricing as well, which will be a substantial savings for the patient.  So in the long run, we actually end up saving our patients more than the membership costs. 

How does this 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 option under the health reform bill.  Once the health exchanges open in October, many people will understand that a Direct Primary Care practice is an approved option. 
• 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 this like MDVIP?

• This is not like MDVIP. MDVIP doctors still contract with insurance companies, and as a result are required to collect a copayment, coinsurance, deductibles, and any non-covered service amounts as required by the health insurance contract, plus the retainer fee, and this is exactly why we chose not to go that route.
• MDVIP doctors also have a much higher retainer fee and require an up-front payment in order to join their practices. We are happy to offer the option of a monthly payment plan, as a more convenient option.
• Lastly, MDVIP offices are unable to sell wholesale medications and lab services.  We are able to do all of this because we don't take insurance.

Does Izbicki Family Medicine accept health insurance?

• Insurance free means exactly what it says: we do not accept health insurance. 
• The most pivotal and difficult decision that we have made is to cut all ties with insurance companies.   Our “care” philosophy is absolutely vital to the health and well-being of our patients, and we are committed to forging a direct personal relationship between you and your doctor.  This allows us the freedom to see patients on our terms without being tied to the rhetoric and rules of insurance companies who are not at all interested in your well being.  

 As a patient of Izbicki Family Medicine, will I still need health insurance?

• Yes. Although health insurance is NOT necessary for membership, it is advised. We do encourage patients to maintain some level of health insurance to help cover the costs of medical care that you receive from medical providers/facilities outside of our practice.
• Insurance will help cover costs associated with, but not limited to, prescription medications, labs, imaging studies (X-rays, CT scans, MRI's, etc.), specialist consultations, hospitalizations, and surgeries.

Can my insurance still be used in your office?

• No.  We are an insurance-free medical practice which means that we do not accept insurance.   This does NOT mean, however, that patients with insurance cannot become members in our practice. 
• Again, payment for services provided through our office will be covered by the membership  fee. The only exception will be for reimbursement of vaccines, when applicable. As non-contracted physicians, all payments for vaccines that we administer will be sent directly to you from your insurance company. We will require that these funds specifically related to vaccines be forwarded to our office upon receipt to cover vaccine-related expenses for you and your family members. There are no other additional charges.
• Because we do not contract with any insurance companies, we do advise you to review your insurance contract regarding "Out-of-Network" benefits for possible reimbursement of services you receive from us.

Are the membership fees reimbursable by my HSA/FSA?

• You may want to check with your human resources department regarding the use of Health Savings Accounts (HSA’s) and Flexible Spending Accounts (FSA’s) as possible payment options for your annual membership. If you are unable to use these funds to pay for the annual membership fee directly, there is a good chance that you can still use your HSA/FSA as reimbursement for certain services provided through our office.

If I have Medicare, can I still join Izbicki Family Medicine?

• Yes. You will need to sign a waiver every two years declaring that neither you nor your doctor will directly bill Medicare for our services. Even though Medicare will not pay us for any services you receive in our practice, 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 any laboratory testing, imaging, medications, or hospitalizations prescribed by our offices.

Is my membership fee at Izbicki Family Medicine tax deductible?

• Unfortunately, it is not. Your membership fee is not yet defined as a “medical expense” in most states and therefore is not tax deductible. The American Academy of Private Physicians, however, is lobbying hard to win rightful deductibility for these expenses. We advise that you discuss this further with your tax preparer or accountant. 

Will I still benefit from a Direct Primary Care practice even if I don’t require frequent medical attention?

• We love that question and we hear it often!  Everyone benefits from medical care personalized directly for them.  Our practice is committed to preventative health maintenance which is a long-term investment in you!  Physicals, i.e., preventative health visits, are not just routine; they are opportunities for early disease detection, much like a state inspection for your car.
• Every visit, regardless of the reason, will give us the opportunity to get to know you better and to build a long-standing relationship over time.  As a result, individual care plans can be developed that are tailored to the individual needs of each patient.  Traditional medical practices, which are insurance-driven, find it difficult to forge this relationship effectively like we are fortunate to do.

Can you help with the costs of prescriptions?  What about labs?

• Because we are an insurance free practice, we have a unique situation where we can directly purchase medications at wholesale cost from the manufacturer.  We will pass these savings directly on to you. 
• In addition, we have a contract with ACL to purchase lab testing at wholesale prices with these savings passed directly on to you.  
• Finally, we have a direct relationship for  imaging studies, such as X-rays, CT’s, and MRI’s, all at a substantial discount. 
• Much like a membership at Sam’s Club, membership in our practice gets you these cost-saving discounts on medications, lab tests, and imaging studies.

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

• At present, our patients, if hospitalized, are seen by the hospitalist. Perhaps down the road we may consider offering hospital care, but for now, we are relying on the hospitalist. Our commitment is to help you avoid being hospitalized by early detection of disease and/or subtle signs that an existing disease state is worsening. Having a non-pressured doctor who is always available to assist in your health care is key to helping to reduce hospital stays. 
• We will still refer patients to specialists as necessary.

Can I contact my physician after hours?  How?

• Of course you can!  We are always here and always available. We understand that illness and injury do not always occur during office hours; therefore, you may call us at any time.  You can contact us via email, cell phone, text message, Skype, FaceTime, Facebook, etc.  We want to be accessible to you!

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

• Contact us!  We can determine the most effective means of communication to determine the best approach to handle your specific situation.  Again, we can connect via email, cell phone, text message, Skype, FaceTime, Facebook, etc.  We’ll help you find the nearest pharmacy and prescribe the medications you need.
• In addition, as a patient of Izbicki Family Medicine, you may consult with other concierge physicians across the country who participate in the National Care Network for Direct Primary Care.

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

• Absolutely not!

How will I know if the doctors of Izbicki Family Medicine are the right fit for me?

• Since you are on our website, you are on the right track already!  If you like what you have read so far, we invite you to call us at the office so that we can personally answer your questions.  Also, please check out our Facebook page.  There are a lot of great topics that may interest you and help aid you in your decision making. 

Can children become members of Izbicki Family Medicine?

• Yes. We are happy to accept children. 
• In terms of vaccinations, please call our office for further details.   

How do I join if the practice is full?

• In order to provide the highest possible level of personalized, quality care to patients who choose our practice, we must limit membership.
• As a result, once our practice membership is full, a waiting list will be established. As openings become available, you will be contacted by a member of our team regarding membership.

What costs are involved in becoming a patient?

• An annual membership fee, paid monthly or paid in full with a 5% discount, is all that is required. This will cover costs of providing care to you and your family throughout the year. We will not charge or collect any copayments/coinsurance/deductibles for visits. When you come for a visit, it’s okay to leave your wallet at home.  You’re covered!