Slider

 

Direct Primary Care

These are some of the most commonly asked questions about the direct primary care model, the care we provide here at Lighthouse Direct Primary Care, and our practice.

What is Direct Primary Care?

Direct Primary Care, or DPC, is a model of healthcare that puts patients first by getting rid of the red tape that constrains traditional practices and the expense of the insurance middle man. How? It’s simple: we don’t accept insurance, and – believe it or not – this actually saves you money in the long run.

How will this save me money?

You won’t have to pay a co-pay for office visits or routine physicals. Also you’ll be able to avoid many visits altogether by sending your questions directly to us via email and text – something you won’t get from a traditional practice. We’ve negotiated amazing deals for prescription medications, blood tests, X-rays, and MRI/CT scans on your behalf. If we had contracts with insurance companies or worked for a large medical group we would be legally obligated to charge higher prices.

More importantly, since you are getting all this amazing care from us, you can cut way back on your insurance premiums. Most DPC patients find a high-deductible, low-premium insurance plan so they’re covered in the case of a major health issue. But leave the rest of your healthcare to us.

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

Of course! We believe that not everyone can be treated the same medically like the big insurance models do. Everyone benefits from a service tailored directly to them. That’s why we offer truly custom healthcare. We’re here for you if you’re sick or hurt, but we also help you proactively maintain good overall health. Every visit with us will be thorough, relaxed, and as long as you need to address your health concerns. The longer you’re our patient, and the more time we spend with you, the more we learn about your health and lifestyle, and the better we can help you maintain that health.

Is DPC the same as concierge medicine?

The terms are often mistakenly used interchangeably, but they are not the same. Both DPC and concierge practices charge a periodic fee, however, under the concierge model, this fee only gets you access; that is, it doesn’t actually cover any of your care. Instead a concierge practice still bills insurance for your visits. Under DPC, your visits and other care are included in your fee, plus you’re provided with other incredible benefits like wholesale pricing for labs and radiology studies, deeply discounted prescription prices, direct digital communication with your doctor, and all the rest.

Membership Questions

So how much does membership cost?

See our prices on our pricing page. We charge a flat monthly fee, and in exchange you get virtually unlimited office visits, greatly reduced prices on prescription medication, your doctor’s cell phone number, and a whole lot more.

What does the membership fee cover?

The fee covers excellent primary care through office visits with no copay. This includes the following: annual wellness exams, sports physicals, school physicals, chronic care office visits, follow-up visits, basic office procedures and treatment of acute illness or minor injuries, all with minimal wait times in the office. The fee also covers direct communications with your doctor: phone, text, video chat or email.

What medical conditions do you care for?

We treat a variety of common everyday problems like colds, flu, strep throat, rashes and injuries. We also treat more complicated long term medical problems like diabetes, high blood pressure, high cholesterol, thyroid disorder, etc.

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

For starters, having such unprecedented direct access to your doctor will help prevent hospitalizations and specialty referrals in many cases. However when those types of care are required, we will certainly continue to work with your hospitalist during your hospital stay as well as work closely with any specialist you require. Depending on the level of care and expertise required, we may rely on those specialized caregivers to manage your treatment.

Can children become members too?

Yes. We are happy to accept the children of our enrolled clients. See our pricing page for details.

Can I contact my physician after hours?

Of course! Physician access is one of the greatest benefits of the direct primary care model. Because illness and injury do not respect regular office hours, you may call, text, or email your physician whenever you need.

What if I need medical attention while I’m away from home?

Because you’ll have your doctor’s email address and cell phone number, you can reach out to us whenever you need, wherever you are. Many illnesses can be diagnosed and treated with a simple conversation or short virtual visit. We’ll also help locate a nearby pharmacy and order the medications most appropriate for your circumstances.

Are my medical records ever shared with government agencies, insurance carriers, or pharmaceutical companies?

We maintain high standards of patient privacy. We will never provide your health information to any third party unless you specifically ask that we do so.

When do I pay my fees for non-covered labs and procedures?

Charges will be applied to your preferred method of payment at the time of collection/completion.

What if I decide to cancel?

You are always welcome to cancel your membership, although we do require 30 days notice.

Is my membership fee tax deductible?

Unfortunately, no. Your retainer is not currently idefined 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.

What is your policy on controlled substances?

We believe that controlled substances, including narcotics (Lorcet, Lortab, Norco, Oxycontin, Percocet, Vicodin, etc.), benzodiazepines (Ativan, Klonopin, Valium, Xanax, etc), and stimulants (Ritalin, Adderall, etc) have a limited role in primary care and therefore Dr. Tinsley prescribes them rarely and only very sparingly. We believe chronic pain requiring narcotics is best managed by a pain management specialist, but we are happy to work with you on non-narcotic options for your pain and to manage your other medical conditions. We do not treat anxiety with benzodiazepines, but are happy to offer other medications and techniques often successful in treating anxiety. No controlled substances are kept in the office.

If I enroll as a patient of Lighthouse Direct Primary Care, when does billing begin?

When you register online through our website you will be charged a non-refundable registration fee. Your monthly billing will start on the day of your first medical visit with the doctor. You should anticipate the doctor requesting you come in for a “Meet and Greet” visit prior to your first medical visit to answer any questions and ensure that this office will be a good fit for you. Please note that medical care cannot be provided through any means prior to an initial intake physical exam.

Insurance

Do you accept insurance?

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 (or pay for gas!). For some reason, health insurance is currently being used for the equivalent of oil changes for humans – routine physicals, office visits, simple blood tests, and minor procedures. This just doesn’t make sense.

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 frees us from the typical contractual agreements that prevent non-DPC physicians from offering wholesale prices on laboratory tests, imaging, and medications.

I don’t have insurance – can I still join?

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 here is eligible for insurance reimbursement. However, we recommend that everyone have insurance coverage, which is still important in the event of a major health issue.

As a patient, will I still need health insurance?

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.

If I have Medicare, can I still join?

Yes. You need only sign a waiver declaring that neither you nor your doctor will directly bill Medicare for our services. Even though Medicare will not pay us for any services you receive in our practice, your Medicare benefits will otherwise remain unchanged and can continue to be used for all other medical care received outside of our practice. Medicare will still cover any laboratory testing, imaging, medications, or hospitalizations prescribed by our offices.

How does DPC work with Obamacare?

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%, thus eliminating the need for ObamaCare-style regulation because we can make health insurance affordable again.

Is the membership fee eligible for HSA or FSA reimbursement?

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.

Is my membership fee tax deductible?

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.

Website by Fresh Look Web Design | Copyright © 2019