Frequently Asked Questions

No, fortunately for both you and us. Perhaps the most critical distinction in our model of care centers on a direct, personal relationship between you and your doctor. That directness carries over to our business model as well. You might use your auto insurance to fix a smashed fender or other major damages. But you’d never use it to get an oil change, regular maintenance, a minor scratch (or pay for gas!). For some reason, health insurance is currently being used for the equivalent of oil changes and things like that for humans – routine physicals, office visits, simple blood tests, and minor procedures. This just doesn’t make sense, it only increases the use of your health insurance which leads to increases in premiums.

We forgo insurance payments in order to save our patients from the arbitrary, intrusive decisions that come with using insurance. Charging a direct monthly fee removes us from the typical contractual agreements that prevent insurance-based offices from offering wholesale prices on laboratory tests, imaging, and medications.

Yes, we take care of any patient regardless of your insurance situation. Since we work completely outside of the insurance system, none of the billing for care with us is eligible for insurance reimbursement. However, we recommend that everyone have some form of insurance coverage, which is still important in the event of a major health issue – high deductible plans with an HSA or health-share plans are two great options.

Yes. We recommend our patients continue a major medical plan with a high-deductible and health savings account. If you experience a major health issue, you will still need insurance to help cover it. We’re happy to refer you to insurance representatives who can help customize an insurance plan to your specific needs.

Absolutely! You are still eligible to enroll in our membership program outside of your insurance benefits.

Everyone’s life situation is unique and as such, only you can make the decision to have additional insurance coverage. Some of our patients continue paying for a traditional health insurance policy, while others might choose a major medical plan with a high deductible and a health savings account. Others, will actually choose to be part of a health-share plan or community like Sedera health or Christian health ministries, among others. If you experience a major health issue, you may still need insurance to help cover those costs.

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%. However, under the 2019 administration, citizens are no longer mandated to have health insurance, so no federal penalty or tax fee exists now. Some states outside of Texas may still impose a state-mandated fee.

You may want to check with your human resources department regarding the use of Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) as possible payment options for your membership. If you are unable to use these funds to pay for the 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.

Unfortunately, no. Your retainer is not yet defined as a “medical expense” in most states and as such is not deductible. Please confer with your tax consultant to clarify tax consequences in your particular circumstances.

Traditional health insurance is expensive and only continues to increase in cost for everyone. Many people including employers can’t afford to pay for traditional insurance for their family or employees. For small/medium businesses and people those stuck in the middle there is another option. A health-share plan acts as a backup to you paying cash for your health services. Sedera Health is one we recommend. You pay a lower monthly premium, pay up to a capped amount per medical need and they negotiate cash rates for you with specialists and hospitals so you don’t have to. Your monthly premium is lower and the larger health costs of the group are shared by all the members. We can help guide you to see if this can work for you, your family or your employees (and you get a discount in your health-share premiums for having a DPC membership!).