Q) Does this mean I don’t need insurance?
A) No, I still recommend insurance for the catastrophic things that may happen such as surgeries, emergencies, hospitalizations, etc. We may also come across a condition that requires specialist care and need to be referred to another provider, this provider will then be able to bill your insurance.
Q) What exactly is covered by the clinic membership?
A) Pretty much anything that the provider in the clinic can do within their space and within the scope of their practice. Office visits, telephone calls, virtual visits, health coaching and in-office procedures are covered 100%. The vast majority (around 80%) of all healthcare needs can be met by primary care within the walls of their clinic. I have negotiated discounted prices with lab and diagnostic imaging and will pass those savings on to you. Clinic members are also able to take advantage of wholesale pricing of medications that are available through the clinic.
Q) Wait…wholesale medication prices? What is that?
A) In the State of Montana, a medical provider may be licensed to dispense medications through their clinic. I will be able to sell them to you for what it costs me to order. I do also charge a small dispensing fee to help cover my cost of shipping of medications as well as the labeling and packaging. I will have a price list of the formulary available in the clinic and oftentimes this is pennies on the dollar of what people pay through pharmacies, even lower than co-pays much of the time. Medications that are not on my formulary list may also be ordered wholesale, but these will be priced individually for each patient. The formulary is simply medications that I plan to keep on hand in the clinic for quick and easy refills/prescribing, other medications will be ordered and delivered with my regular medication deliveries, so may have a delay in dispensing. The costs of any medication dispensed through the clinic is completely transparent. You will know how much it cost me to order it, as well as how much it will cost you to purchase. No surprise fees here!
Q) Do I have to order my medications through the clinic?
A) Absolutely not! I offer this service as a convenience for members of the clinic because we do not have a pharmacy locally. As a provider who can dispense medications, not only am I not out to make money off of the medications I dispense, but I feel it would be unethical to sell for a profit.
Q) Will my clinic membership cover the cost of lab tests?
A) If it is a lab that I can physically perform in the office, yes. But if it is a test that must be sent to a lab to be done, no, but I have negotiated cash prices with a lab company to make labs affordable for my members. I will have a list with all of these prices available and we will discuss the costs before the labs are drawn. This agreement with the lab means that the lab will bill me directly for the tests and I will in turn bill you. For those who have not met their deductible, this savings for a single test could potentially pay for their entire monthly membership fee, simply by skipping insurance. If you would like to bill your insurance (because it rocks and covers everything better than cash price) we can absolutely send the sample with a copy of your insurance card for the lab to bill to them, you will then be responsible for any cost not covered by the insurance.
Q) What do you mean by unlimited access to my provider?
A) Exactly what it says. You are welcome and in fact encouraged to come in for as many visits, for as long as it takes until your questions are answered and needs are met. My members have my phone number, email address and multiple ways to contact me 24/7 if needed. Life does not only happen M-F 8-5 and I want to be available for when your child has a fever at 11pm that won’t come down or that midnight snack means the knife slipped and you need a couple of stitches. While most of our cares, med refills, physicals, sick visits, medical questions, follow up appointments, etc can be dealt with during “business hours”, sometimes we need flexibility in care. If a phone call about the midnight snack incident reveals you need stitches that I can do in office, I’ll meet you at the office to take care of it. If your other kiddos are sleeping and the one with the fever needs to be checked on, I’ll come to your home to check on her if I am able. If we decide that the after-hours problem is too large to deal with through primary care, I will refer you to an emergency department, but will be sure to call ahead so they know the basics of what is happening.
Q) Does my membership cover the Emergency Room visit?
A) No. This is why we should still have insurance, for the problems that can’t be dealt with in a primary care office.
Q) If I go to the ER and am admitted to the hospital will you be my provider there?
A) I do not have hospitalist privileges in any hospitals, so we will rely on the hospitalist services to take excellent care of you while inpatient. If you are having questions that are not being addressed, I will be happy to come visit you in hospital and try to “translate the medical speak”, but I will not have authority to make changes in the hospital.
Q) Will you see people who have Medicaid or Medicare?
A) I will happily see patients who have these insurance plans however I cannot bill your insurance for your care in my clinic and you will be required to sign a form that acknowledges this. As of right now, no insurance company will reimburse for the cost of DPC membership.
Q) Can I use my insurance to pay for tests and medications that are ordered by Ponderosa Clinic DPC outside of the clinic?
A) Yes, you may use your insurance policy to pay for outside tests, medications and procedures. I always recommend that you contact your insurance carrier to check on requirements and reimbursement rates, as every policy differs.
Q) What if I can’t take enough time to come to the clinic?
A) Not all visits/encounters NEED an in-person visit. Oftentimes we can deal with your questions, medication refills, follow-up discussions and check ins by phone, text, email or video call. I do recommend an in-person visit at least once per year for physical exam and for things that require that I look/listen/feel, such as a sore throat, cough or injury. Much of the time, a follow-up visit is just checking in to make sure you’re doing ok with a new medication or lifestyle change that was recommended. When a provider is using the traditional insurance billing model of care, they are not reimbursed for the time they take to talk on the phone with you and therefore will frequently ask you to come back multiple times when a phone call will suffice.
Q) You say I can take all the time I need to get my questions answered, but how long does it take to get an appointment?
A) Within 24-48 hours during the “work week”. If an appointment is not available online, you can call or text and we will get you scheduled appropriately. We have online self-scheduling available so you can choose your own appointment times during the set work week schedule. As of right now, our anticipated work week is Monday through Friday, but I fully expect to start flexing the days and hours of time that I am in the clinic and appointment slots are open to include evenings, early mornings and/or weekends.
Q) Do you take walk-ins for members?
A) Yes, but I do recommend an appointment time be scheduled, because this allows me to manage time and provide each member with the amount of time they need for their visit. Since we may be flexing office hours, simply going online to check available times will decrease the chance of getting to the clinic to find that I am not there. If you are having an urgent medical need during the times I am not scheduled to be in office, refer to the question about unlimited access…give me a call and let me know you need to be seen urgently. As always, if you are having a medical emergency, I recommend that you call 911.
Q) OK, I’m almost convinced but how much will this cost me?
A)
Single adult - $75
Couple - $130
Per child (under 18yo) - $30
Family (couple + 3 or more children) - $200
Enrollment fee - free initial
Re-Enrollment fee - $100 per person
Q) What if I want to cancel my clinic membership?
A) I would hate to see you go, but if either the member or provider decide that Ponderosa Clinic DPC is not a good fit, we will be able to sever the membership/relationship with a 30-day notice.
Q) What if I’m still not convinced this type of clinic membership is right for me?
A) I offer free Meet & Greet visits where I will be able to answer all of your questions about how the clinic works and what we can provide for you. No healthcare decisions will be made during this visit, but we can consider it a job interview to decide if you would like Ponderosa Clinic DPC to work for you.
Q) Can I use my HSA (health savings account) to pay for my DPC membership?
A) As of right now, probably not unfortunately. Contact your HSA servicer and ask about it. Many HSAs require proof of a fee for a service or supply in order to reimburse you and DPC membership fees are not a traditional fee for service. You may be able to get reimbursement from your HSA for medications and labs, however. The regulations regarding DPC are changing rapidly and as this model of healthcare becomes more well known, I suspect that many others who make the regulations will see the benefit of DPC and change accordingly.