Direct Primary Care (DPC) is a return to what many would call "old fashioned" medicine. It is a direct financial arrangement between patients and their physician...no insurance companies! By becoming a member, patients receive all the professional services offered by the physician for a monthly (or yearly) subscription fee. As an added bonus, patients receive wholesale prices on lab tests and medications.
As one of the first practices in Maine to adopt the DPC model, we have helped many other practices throughout Maine, New England and the US convert to or adopt the DPC model. Additionally, we have had the privilege of serving as a Founding Member of the Maine Direct Care Network, the New England Direct Primary Care Alliance and the recently established Direct Primary Care Alliance.
Is Direct Primary Care insurance?
Simply put, no. It was not and is not intended to be "insurance" but rather affordable care for the masses.
What impact does the Direct Care Plan have on my existing insurance plan?
Does the Direct Care Plan meet the Affordable Care Act/Obamacare requirement to have health insurance?
At this time, in and of itself, no. Although the requirements of the Affordable Care Act seem to change daily, Direct Primary Care does not fulfill the requirements currently set forth by the Affordable Care Act. It does, however, reduce out-of- pocket expenses for the most common types of care, such as yearly physicals, routine office visits for illnesses and injuries, lab testing and medications.
What about catastrophic coverage?
We strongly recommend that all patients have some sort of catastrophic coverage and actively recommend the cooperative plans such as as those from Liberty Share, Medi-Share, or Samaritan which provide catastrophic coverage and are exempt from the penalties associated with the Affordable Care Act.
If I enroll in the Direct Care Plan, will my insurance company cover lab testing, prescriptions, and referrals to other physician?
The benefits you receive from your insurance company are determined by... well, the insurance company, whose sole purpose is to be profitable. They should honor any lab or diagnostic testing, prescriptions and referrals ordered; however, that doesn't mean that they make it easy for patients and physicians. We encourage all patients to familiarize themselves with their coverage benefits as insurance companies routinely require "prior approval" or "prior authorizations" for routine diagnostic testing and services.
As an alternative, we have partnered with like-minded companies to offer affordable lab testing and medications. We are also building collaborative relationships with multiple specialty physicians to ensure that you can receive the care you require, regardless of the changing insurance company rules.
Will I need to choose a new Primary Care Physician (PCP)?
Only if your insurance company demands it.
If I choose not to sign-up, can I still receive my care here?
Of course! You won't be able to access those services available with the membership, but we will continue to provide you with high-quality, comprehensive medical care if you decide our cost-effective membership plan is not a good fit for you. While we provide a publicly available price list for common services, please do not hesitate to ask us for a price estimate if the service is not listed. Payment for services is expected on the day you receive them. We will provide you a receipt which you can submit to your insurance carrier for possible reimbursement.
Where can I find more information about the Direct Primary Care membership plan and where can I sign up?
Signing up is the easy part! Simply complete our signup form and you're ready to go!
Our Direct Primary Care membership plan is focused on alleviating the burdensome and escalating costs of healthcare and built around providing the best, high-quality, cost-effective care possible.
At the heart of the plan is Wellness Care, which includes comprehensive annual examinations, lifestyle evaluation, a review of applicable preventive healthcare and treatment options, and a written plan for each member of your family.
Our Direct Primary Care membership plan includes:
- Annual physical and wellness examination, including a thorough review of dietary and lifestyle, detailed review of preventive healthcare recommendations based on current medical research, and a written, comprehensive plan designed to help you achieve the healthiest state possible
- Flat rate $35 charge for office visits (per patient). It doesn't matter if you're scheduling a visit for chronic disease management (e.g., diabetes, hypertension, chronic lung disease, heart disease, obesity, high cholesterol), seeking treatment for an acute illness or injury, undergoing a minor surgical procedure, Osteopathic Manipulative Treatment or all of the above...the rate remains the same $35 per office visit.
- Discounts on most medication (as much as 75-90% off pharmacy prices)
- Discounts on lab testing (e.g., cholesterol panels, thyroid testing, metabolic panels). For your convenience, lab tests can be drawn in our office and results are typically communicated to you within 48-72 hours either by phone call, email or through our secure texting application.
- Access to your physician...the same physician, at every visit
- Access to your physician after hours and on weekends through our secure texting application, Spruce.
What is not included?
- Services provided by another physician or healthcare institution, such as hospitalizations, consultations with specialists and imaging studies such as CT scans, X-rays and MRIs.
- Legal proceedings. In the rare instances where a service such as a deposition is needed, we are happy to negotiate a special rate with your attorney.
- Pregnancy care. We have a special package devoted to pregnancy care which, by recent estimation, is 50-75% less than the cost at other offices.
What is the cost of membership?
- Individual: annual discount of $1,250/year (single payment) or 2 payments of $750 (at 6 month intervals). Monthly installments are available on our sign-up page.
- Family (parents and children): $1,750/year (single payment) or 2 payments of $1,000 (at 6 month intervals). Monthly installments are available on our sign-up page.
- $35 office visit charge per visit per patient
- One-time enrollment fee of $99