Paying for Primary Care – Traditional vs. Direct Primary Care

Primary care costs

Maybe you have a sore throat. You’d like to know if it’s strep throat or not, but office visits under your insurance plan can be prohibitively expensive, so you decide to give it another day (or two). These kinds of decisions happen all the time. In fact, you’re probably used to thinking of healthcare as a series of calculations, weighing your wellness against inevitable (and possibly unbearable) financial costs.

But when you’re a member of a direct primary care clinic, that calculation becomes very simple. All of your primary care needs are covered by a simple monthly payment, so the only thing you ever need to think about is your health. It’s simple, easy–and an enormous relief. And it’s only the start of the benefits you can receive from being a member of a direct primary care clinic.

Benefits of Direct Primary Care

Under a direct primary care system, you pay a monthly membership fee. That fee covers all of your medical costs from that clinic–tests, checkups, visits, phone calls, you name it. This type of setup is still relatively novel, but it’s quickly growing in popularity. Mostly, that’s because of the real and tangible benefits patients experience, some of which you can find below.

Your Direct Primary Care Doctor Becomes Your True Advocate

Traditional primary care clinics run on a very high patient-to-physician ratio. That’s why visits to  those clinics tend to feel rushed. If you’re lucky, you get a few minutes uninterrupted with your doctor to ask questions. In those traditional settings, the emphasis is on addressing your symptoms and getting you out the door as quickly as possible.

A direct primary care clinic flips this on its head. Because of the way they’re structured DPC practices can operate on a very low patient-to-doctor ratio. This means you can spend time with your physician, developing a relationship and a rapport. Because your direct primary care physician can spend more time with you, they can get to know your health better. That’s what makes a DPC clinic the perfect place to address the root causes of health and wellness concerns you might have.

Same Day Visits and Better Scheduling

We all know what going to the emergency room for a sore throat or an achy ear can be like: you’re in for a long wait and a terse visit with a doctor you’ve never seen before. But a typical primary care clinic might not be able to fit you in for days, so under a traditional system you may not have much choice.

That’s another area where a direct primary clinic proves to be beneficial: with a DPC, you can enjoy same day appointments. So if you’ve got a cough or a fever that won’t go away, there’s no need to visit an urgent care or emergency department. You simply make a same-day appointment with your direct primary care doctor. What’s more, at a DPC, same-day visits do not incur any additional charges. It’s all covered by your monthly dues.

Better Communication with Your Physician

Have you ever wanted to get in touch with your doctor to ask just a quick and simple question? Maybe you need some clarification regarding your medication and need a fast answer. Maybe you’re worried about a one-day fever spike. When you’re a member of a direct primary care clinic, you’ll have multiple, convenient ways of contacting your doctor. You can write a quick email or send a text right to your doc. And what’s better–you can be pretty confident in a prompt response.

That’s why direct primary care clinics have also been early adopters of telemedicineMost DPC clinics these days offer patients easy ways of scheduling televisits at no extra cost. Face time with your direct primary care physician is essentially unlimited–covered by your membership–so you never have to worry about the financial cost of each conversation.

You Know What You’re Paying

Price can be a big concern when you’re thinking about medical care. When you’re a member of a direct primary clinic, you’ll know what you’re paying for medical services every step of the way. The vast majority of all your primary medical needs are taken care of by your monthly dues. There are a few exceptions, such as the rare immunization here or there, that may require additional expenses–but you’ll always be aware of additional costs up front.

That’s not always true at all membership-style clinics. A concierge medicine model, for example, will charge you a monthly fee but will still also continue to bill your insurance company. So you won’t be entirely clear on what you’re paying or to whom.

At a direct primary care clinic, you will always know exactly how much you’re paying for care. There are none of the confusing copays, deductibles, caps, and other insurance gimmicks that lead to surprise expenses (and delayed care).

A benefit of our practice in particular is that we dispense prescription medications at a discount to our members. Discounts are usually lower than the co-pay at many pharmacies. Our patients like the convenience of skipping the trip to the pharmacy and the lower costs.

Your Insurance Company Stays Out of Your Primary Care

One of the biggest benefits of direct primary care is that all of the medical decisions are handled by you and your doctor. When you’re a member of a direct primary care clinic, you don’t have to check with your insurance company before you undergo care. There’s no insurance company getting in the way, telling you what’s covered or not.

All medical and healthcare decisions regarding your primary care are left to you and your doctor. If your job changes, you don’t have to switch doctors. One simple monthly payment–to your doctor, not to your insurance company–and all of your primary care needs are taken care of. Imagine: no more fighting with your insurance companies, no more surprise bills–just the care you need when you need it.

You Get Additional Services

Direct primary care clinics will generally cover the vast majority of your general care needs. Some clinics may also provide enhanced or additional services. Because DPC clinics are not beholden to insurance companies’ rules, DPC clinics are free to offer additional services as they see fit. These services may change from clinic to clinic. At Progressive Health Primary Care, for example, we provide the following additional services for our patients:

  • Covid-19 Testing: Public Covid-19 testing isn’t as prevalent or readily accessible as it once was. To help patients stay safe and manage their health, we offer both rapid antigen and PCR Covid-19 testing. Covid-19 tests can help you feel more confident before socializing with vulnerable family members or provide the necessary clearances for work or travel. They can also provide you with peace of mind and help you get the treatment you need!
  • Pharmacogenetic testing for mental health: Traditionally, finding the right medication for mental health symptoms has required a process of trial and error. For patients, this process can be quite frustrating. Pharmacogenetic testing looks for genetic markers that suggest which specific mental health medication would be a good fit for your needs. As a result, the trial and error process is typically much more successful (and much shorter).
  • Medical cannabis consultations: Whether you already have your Illinois medical cannabis registry identification card, are seeking a renewal, or need help getting the process started, medical cannabis consultations can help. In many cases, other physicians may have no idea how to properly use cannabis to help treat qualifying conditions, such as PTSD or chronic pain. During a medical cannabis consultation at PHPC, you’ll receive expert guidance–and you’ll know what to expect every step of the way.
  • Prescription medications: Many direct primary care clinics, such as Progressive Health, have their own pharmacies. Your membership at Progressive Health can help offset the prices of many of these medications, resulting in a significant discount for our patients.

These services are all included with your monthly membership (meaning you won’t have to pay anything out of pocket) or are significantly discounted (meaning out of pocket expenses are greatly reduced). If you have questions about any of these additional services, contact us directly at Progressive Health!

Scratching the Surface

The benefits of direct primary care can be long reaching and robust, impacting both your wellness and your wallet. If you have questions about direct primary care or want to become a member, contact our offices today.