Direct primary care (DPC) is a different type of medical care model that does not involve billing insurance companies for primary care. Most of us are familiar with the “fee for service” model insurance only pays for an office visit (service). In this model, schedules are stacked tightly in order to assure enough services are done for the day. However, this does not include phone calls or messaging. Everything must be an appointment. And the insurance company can decide how much they may or may not pay regarding the service. DPC practices charge a flat monthly fee direct to the patient. Pricing is transparent and there is no need to sort through confusing and unpredictable bills. This membership fee covers the annual wellness visit, acute visits, that phone call or message to clarify an answer. The focus is taking care of the patient, not how many diagnoses, fees and services can be added into a 20 to 30 minute appointment slot. DPC practices are able to have smaller patient panels compared to a traditional model because the focus is on quality care versus quantity of care. Because of this, the appointments are longer, usually 30-60 minutes.  Patients can usually schedule a visit or have their concern addressed directly by their physician within 1-2 business days, rather than long waits for appointments and/or delegating your care to other people. With smaller panels and bypassing the extra paperwork needed for insurance company reimbursement requirements, we get to do the job we love, take care of our patients, and go home to our families without having to bust out the computer for all the administrative tasks that are not covered in the day in the model of running from one room to the next because we were already behind trying to give the care our patients need. And for those that are still asking why we went DPC:We need better work-life balance as physicians so we can have a sustainable practice and continue to take excellent care of our patients without the moral injury and burn out that is so highly associated with this career field.

Direct Primary Care practices do not bill insurance. Insurance does not cover membership fees, because insurance is based on fee for service. Most services are covered within the membership fees, and the cost associated with in office procedures are low enough that it may not be worth the headache to submit for reimbursement. Insurance can still be used for referrals to specialists, ER visits, imaging, and hospital stays (things outside the primary care practice).

While insurance is not required, it is recommend. A membership with a Direct Primary Care office should cover most of your primary care needs. However, insurance is still helpful for services we do not directly provide such as specialty care, ER visits, hospitalizations and surgery.Some patients find that catastrophic plans or health sharing plans pair well with Direct Primary Care.

In both models, patients enjoy the individual attention and communication they deserve from their physicians. In addition, both concierge and Direct Primary Care practices work off memberships models.However, DPC doctor's goal is to charge affordable rates in order to serve regular, working people. DPC does not bill insurance. Concierge doctors charge thousands of dollars and also bill insurance.

The process for seeing a specialist does not change if you join a Direct Primary Care Practice in that you can use your insurance for the consultation. This is also true for hospitalizations. We will also be offering heavily discounted cash prices for labs and have knowledge on affordable cash pay imaging services for those with high deductible health plan though you can always choose to use your insurance at a location of your choice.

You can now use your pre-tax HSA funds to pay for monthly DPC membership fees, subject to limits of $150/month for individuals and $300/month for family.

The New England Direct Primary Care Alliance and its members believe that everyone benefits from medical care personalized directly for them. We are committed to preventative health maintenance which is a long term investment in you!Physicals are not just routine, they are opportunities for early disease detection. And 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 and every patient.