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FAQs

What is Direct Primary Care?

Direct Primary Care (DPC) is a healthcare model where patients pay their PCP directly for comprehensive services via a monthly or annual membership. The provider does NOT bill the patient's insurance, and therefore is not required to spend hours on tedious coding and billing. Instead, the PCP spends that time caring directly for their patients, cultivating strong provider-patient relationships. DPC is NOT a replacement for insurance, but compliments it by covering the vast spectrum of primary care needs. DPC also creates opportunity for uninsured/underinsured patients to engage in preventative healthcare and health maintenance at an affordable, transparent cost.

 

How is this different from a traditional clinic?

One of the main differences is the size of the provider’s patient panel. Traditional Primary Care Providers have a panel size of 2000-3000 patients. Your provider will have a panel of only 300 patients affording a higher quality patient-provider relationship with more time and focus on your unique healthcare needs. Another main difference is accessibility. You are able to communicate with your PCP when you need to, and schedule appointments at your convenience. 

 

Is DPC the same as Concierge Medicine?

No, although this is a very common misconception. Both charge a periodic fee, however with concierge medicine, the fee only gets you communication access to your PCP; and doesn’t include any of your care. Concierge practices still bill your insurance for your visits and medical care, therefore requiring you to pay copays and leaving you vulnerable to surprise bills. 

 

INSURANCE

 

Is Direct Primary Care insurance?

No, it is not health insurance and does not replace traditional health insurance. DPC patients are still recommended to carry health insurance, especially for “catastrophic coverage”. Generally, a “low premium, high deductible” insurance plan works well with a DPC membership. DPC practices are able to accept patients without health insurance.

 

Does Amalura Health bill my insurance, Medicare or Medicaid?

No. Since we work directly for the patient, we never bill any insurance companies or programs.

 

Can I still use my insurance company for lab testing, imaging, referrals and prescriptions?

A vast majority of insurance companies do cover preventative or screening lab work, imaging, prescriptions and referrals ordered by DPC providers. However, there are exceptions which is why it is recommended that all patients become familiar with their coverage benefits. As with Traditional Primary Care practices, sometimes insurance requires a “PA” (prior auth or prior approval), which your DPC provider is prepared to manage on your behalf. Many DPC patients opt for a low premium/high deductible insurance plan so they’re covered in case of a major health issue. Your provider can help you navigate the healthcare options from your employer (or from the marketplace), and connect you with an insurance specialist or other resources as needed.

 

GENERAL

 

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

Yes, of course! Not only does your provider really get to know you, but you won’t have the aggravation of navigating the traditional healthcare system when you actually need medical care. Additionally, you always have access to your provider for questions or concerns that pop up in your daily life. Getting real time advice on the ways you’re already working to maintain your health provides significant peace of mind.

 

What happens after hours or on weekends?

We still have you covered! For guidelines on communicating with your PCP, please refer to our Member Connect page. 

 

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

Your provider will coordinate any necessary referrals to providers in your insurance network. Specialists will bill your insurance for services they provide. 

 

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