What is Direct Primary Care?
Direct Primary Care (DPC) is an innovative alternative payment model improving access to high functioning healthcare with a simple, flat, affordable membership fee. No fee-for-service payments. No third-party billing. The defining element of DPC is an enduring and trusting relationship between a patient and his or her primary care provider. Patients have extraordinary access to their healthcare team and providers are accountable first and foremost to their patients. DPC is embraced by health policymakers across the spectrum and creates happy patients and happy doctors all over the country!
Better Health Outcomes
Patients achieve superior health outcomes with Direct Primary Care’s innovative service delivery. DPCs provide better access to providers, empower an authentic therapeutic relationship, and comprehensive patient care.
Affordable, transparent costs based on a periodic overall flat rate. Patients pay for their care directly to New Smyrna Beach MD DPC. No third parties or Fee for Service billing (“FFS”) to inflate costs. Our DPC membership costs less than the average cell phone bill.
Enhanced Patient Experience
Patients receive extraordinary access to their healthcare team, report little to no wait time, and receive comprehensive communication (in person, virtually, or by phone). In turn, creating a real therapeutic relationship between patient, provider, and their healthcare team.
Do I have to have insurance?
No, but we recommend you have some form of insurance to cover unplanned emergencies in your health. Due to the low monthly fee, membership-style payment plan, DPC eliminates the expense of a full-coverage insurance plan. High Deductible Plans also known as Catastrophic/ “Wrap around” plan is still recommended and required by the Affordable Care Act (ACA) when on the exchange. However, DPC replaces the need for a high deductible, full-coverage plan with a plan insurance was made for- covering catastrophes. Full-coverage insurance plans are normally twice the cost of a stripped-down catastrophic insurance plan.
Is there a contract?
Yes, but it is a month to month contract and can be terminated at anytime with 30 day notice. Florida law stipulates minimum contract language which a direct primary care contract must contain. The contract recognizes that DPC plans are not insurance, describes the type of services and correlating fees covered by the membership, and explains how to terminate.
Do we accept insurance?
New Smyrna Beach MD DPC is a self-funded membership program only however, New Smyrna Beach MD is in network with many major insurers and does care for patients outside of the program with Fee for Service insurance billing. Unfortunately, patients can’t participate in the membership program and use their insurance in our office – if patient’s have insurance they must choose one of the two options and may not use both. New Smyrna Beach MD DPC IS NOT INSURANCE. Due to regulations, New Smyrna Beach MD DPC is not available to patient’s eligible for or enrolled in Medicare. For healthcare expenses outside our office, we can help you find the combination of healthcare, and health insurance that saves you money when combined with our direct care model.
How do I pay for services?
Once enrolled, New Smyrna Beach MD DPC is billed monthly on a recurring autopay setup to your debit or credit card or by ACH bank withdrawal from your checking account. Payments will be debited monthly on the same date of enrollment every subsequent month.
Can I get membership through my employer?
Yes. We are a great option for small business owners and self-funded companies who are looking to provide great benefits for themselves and retain great employees.
Most importantly, a self-funded plan benefits financially right away from the savings on copays, procedure fees, in-office labs, imaging, & decreased ER/Urgent care usage.
New Smyrna Beach MD DPC can lower ER/Urgent care visits, hospital costs and specialty costs through improved access to care and more frequently addressed healthcare needs. DPC can lead employees to be healthier, more productive, and more satisfied with their healthcare experience.
We are happy to present our program to any Employer that would like more information.
Can I use my Health Savings Account to pay for Direct Primary Care?
The law currently allows the use of HSA money to pay for medications, imaging tests, labs, etc. No, HSA funds cannot be used to pay for DPC membership fees. Legislation has been proposed to clear up the question regarding if HSA money can be spent on a DPC physician’s retainer or membership fee.
Can I get all my medications through NSB MD DPC?
No, we do not dispense medications for DPC members currently, however we are always keeping up with the latest and greatest saving opportunities in the pharmaceutical industry. Good Rx and many other prescription saving coupons are available to take from our office to the pharmacy and we are almost always able to prescribe a generic alternative.
How can I contact the provider after hours?
We know that illness and injuries don’t always happen during office hours. If you just need to get in touch with us to order a medication refill or schedule an appointment, you can call the office, message us through your portal or leave a voice mail and we will always get back to you at the next earliest opportunity upon return. If you have an urgent or emergent issue after hours, CALL 911 AND/OR GO DIRECTLY TO THE EMERGENCY ROOM.
Is this concierge medicine?
No. However, there is overlap between direct primary care and concierge medicine. The most important difference is in the cost and billing structure. In general, concierge practices charge and annual retainer along with billing insurance. The typical annual retainers are over $1800 per year. Direct primary care practices generally charge monthly fees which tend to be less than $100 and generally do not also bill insurance for other services. Both concierge medicine and direct primary care strive to improve the experience you have at the doctors office by making care more personal and taking more time to listen.
I own a small business. How can you help me?
Absolutely! We are happy to partner with you to bring our quality services to your employees and save them time away from work waiting at the doctor’s office. Please call us if you would like to learn more.
What if I need a specialist?
If specialty care is needed, we have a large community of specialists that we work closely with. We will communicate carefully and consistently with specialists to be sure you receive an appropriate consult.
What is not included in my membership?
Our Primary care services can often address the vast majority of an individual’s health care needs. However, some services are not included in the direct primary care program. Patients are encouraged to combine New Smyrna Beach DPC membership with a high-deductible insurance policy to cover specialist physician and hospital services.
Our membership does not cover the cost of such services as:
- Laboratory Services
- Medical Imaging
- Pharmacy Services and Prescriptions
- Specialist Care
- Emergency Department Visits/Hospitalization
What if I’m having a medical emergency?
As is customary with any true medical emergency, CALL 911.
What if I need care on the weekend?
If you have an urgent after-hours concern that you believe cannot wait for routine business hours, we encourage you to visit one of the local urgent care or emergency centers that will coordinate care and transmit the records to us appropriately. If you are having a medical emergency, CALL 911
So, no matter when I need you- you’re available?
No…not exactly. We are primary care physicians. This means we can address most problems, most of the time. We are cultivating something sustainable, enjoyable and trans-formative. And it requires a partnership with our patients. In this age of instant responses and digital access, we are striving for sustainability. We ask our patients to utilize our services, in person or electronically, when they need us. We also ask that if matters can wait that they do.
What is Considered an Emergency?
Urgent care is not a substitute for emergency care. In general, an emergency condition is one that can permanently impair or endanger the life of an individual. Some examples of conditions that require emergency medical care include:
- Severe chest pain or difficulty breathing
- Compound fracture (bone protrudes through skin)
- Convulsions, seizures or loss of consciousness
- Heavy, uncontrollable bleeding
- Deep knife wounds or gunshot wounds
- Moderate to severe burns
- Serious head, neck or back injury
- Pregnancy-related problems
- Severe abdominal pain
- (Signs of) Heart attack (i.e.. chest pain lasting longer than two minutes)
- (Signs of)Stroke (e.g. loss of vision, sudden numbness, weakness, slurred speech, or confusion)
- Suicidal or homicidal feelings
What is Considered an Urgent Medical Condition?
Urgent medical conditions are ones that are not considered emergencies but still require care within 24 hours. Some examples of such conditions include:
- Accidents and falls
- Sprains and strains
- Moderate back problems
- Breathing difficulties (i.e. mild to moderate asthma)
- Bleeding/cuts — not bleeding a lot but requiring stitches
- Diagnostic services, including X-rays and laboratory tests
- Eye irritation and redness
- Fever or flu
- Vomiting, diarrhea or dehydration
- Severe sore throat or cough
- Minor broken bones and fractures (i.e. fingers, toes)
- Skin rashes and infections
- Urinary tract infections
Dial 911 immediately for any Medical Problem that Appears to be Life-Threatening