Frequently Asked Questions

Why is direct pay better?

Conventional insurance-based medical practices are becoming unwieldy with more employees and time spent just on billing and collections. Insurance companies dictate the type of care doctors give, and doctors have to see 25+ patients a day to maintain their business. Many times, the cost of billing is more than the fee itself.

Direct primary care allows physicians the freedom to serve patients and practice medicine the way they were trained. No billing means doctors have time to spend with patients, and patients can access the doctor when and where they need to.
Ultimately, direct primary care allows for more than just a better version of what is already there. Doctors are able to redefine the frontlines of care by providing proactive and preventive care that is otherwise unavailable in the traditional system. This leads patients to experience better service while having better health – namely fewer surgeries, specialist visits, hospitalizations, and medications.

Do you have evidence that direct pay costs less?
Numerous reports show better care and cost-saving throughout the United States. In North Carolina, DPC saved $1.28 million in health care claims in one year for 2000 patients. In insurance-based medical clinics, 43% of the day is spent on administrative paperwork.  By eliminating this non-value-add paperwork, doctors have more time to spend with patients and manage their medical conditions. More time also means better access which leads to fewer specialist referrals, hospital admissions, and ER visits. In fact, patients enrolled in a DPC program have 59% fewer ER visits, spend 30% fewer days admitted to a hospital, are referred to specialists 62% less, and have 80% fewer surgeries.
After Hours

My practice leverages a telemedicine app that allows me to be available after hours, especially for urgent concerns. This dedicated tool allows us to securely text, video chat, and share photographs in real-time.

How are office visits handled?

It’s easy – schedule a visit via secure messaging or phone and then come into the office to see me when your visit is scheduled. You and I also have the option to televisit for a quick checkup or if you would prefer not to come in. As a member of my practice there are no additional charges to see me!  Ever!

 

Will you allow me to see you without signing up for full membership?

I would definitely suggest joining my practice as a membership because this allows you to take advantage of unlimited visits, the ability to call/text/message me directly anytime, virtual video-chat visits, home visits, free procedures such as joint injections & mole removals, and deeply discounted prices on many lab tests and medications.

Studies have shown that people with a good primary care doctor live longer, healthier lives.  That combined with the notion that ‘ the devil fools with the best laid plans,’ it’s best to use a membership to establish a relationship with me so we can get ahead of any problems that may pop up.

If you aren’t sure that a membership is right for you, whether your reasons are financial, related to your current health status, or born from something else, I’d be happy to sit down with you and help you work through your decision.

À la carte services are available for non-member patients.

How can I be sure you will have time for me if your access is unlimited

My main priority is you.  When I worked in the mainstream model of care, nearly 3000 patients knew me as their primary care physician. I regularly had a 3-month wait to see me and visits were scheduled for 15 minutes only.  Birchwood Family Medicine allows me to limit my patients to no more than 600. This limit combined with the abolition of insurance-driven paperwork, allows me to offer same or next-day appointments, to take as much time as needed with you and to provide you access to your physician unlike anything you have experienced before.

Hospitalization

As your private physician, I would like to be involved in any care you seek elsewhere —whether that’s in an emergency room or after admission to the hospital. We are also happy to support your family during a hospital stay and help arrange any additional care you may need upon your return home.

INSURANCE

My practice welcomes all patients, regardless of their insurance status. I do not bill insurance, but you can use an HSA or FSA to pay for your membership annually if you wish. If you have private insurance, you may submit a claim form to your insurance company to be reimbursed directly, though it is likely our clinic will be considered “out of network.” Reimbursement will depend on your policy with your insurance company. If you are looking for a cost-effective way to obtain catastrophic care, we recommend you enroll in a healthshare. This new type of health plan is affordable, provides great service, and is actually useful to alleviate any emergency medical bills.

I like to explain that everything done within the walls of Birchwood Family Medicine and everything done by me is covered by membership. If you need to go outside the office – for example, to see a urologist or have chemotherapy done, you can use insurance like you normally would. My inexpensive cash pricing can drastically reduce healthcare costs for those without insurance and for those who are used to high deductibles and co-pays.

MEDICARE

Medicare offers a minimum of primary care services via industrial health care, which limits a patient’s personal access to their primary care physician. My practice is excellent for the Medicare patient who values having unlimited access to a primary care physician that knows them. My Medicare patients pay their practice fees directly, but their Medicare coverage remains in place for everything else: other specialty care, testing performed outside of our office and hospitalizations. Your Medicare will also cover lab services as these are performed by an independent lab affiliate. Rest assured that I can refer, prescribe, and otherwise fully act as your primary care physician.

 

HEALTH SAVINGS ACCOUNTS (HSAs)

Our membership is a ‘qualified medical expense’ and as such, our fees are compliant with flexible spending (FSA) and health reimbursement accounts (HRAs).  Membership is generally considered compliant with HSAs as well.  If you plan to submit your membership expense to one of these accounts, I recommend paying annually, or at least semi-annually to minimize the frequency with which you submit expenses for reimbursement.

 

CONTRACTS

The Birchwood Family Medicine service contract is for one year. If you wish to cancel your contract, for any reason, you may do so with a 30-day notice. Any services already performed will be itemized for payment and once settled, any refunds due will be paid.  Contracts are otherwise automatically renewed unless a 30-day notice is received prior to the date of renewal.

How do I pay for your services?

We recommend setting up your monthly membership payments to be automatically withdrawn from your bank account.  That said, you may also pay with cash, credit card or check. I request and recommend keeping your payment information on file through our secure business vendor to enjoy the convenience of paying for both:

  • your membership fees, inclusive of all in-office visits, procedures and telemedicine (at your preferred interval of monthly, quarterly, biannually or annually)
  • any additional services (e.g. lab work, imaging, vaccines, medicines offered at deeply discounted cash prices) you choose to purchase outside of your insurance coverage.

If you are going to use your Health Savings Accounts to pay your membership fees, payments need to be made every 6 months or annually.

 

WHY DO I NEED MEMBERSHIP TO A PRIMARY CARE PRACTICE?

Conventional insurance-based medical practices have become unwieldy, with more staff, time and money being spent just on billing and collections. Insurance companies dictate the type of care they will pay for, directly affecting the type of care doctors can actually give.

Patients and insurance companies pay the doctor on a visit-to-visit basis and most insurance companies will not pay a doctor unless they see you in the clinic. This causes the doctors to have you come into the office and bill you every time you want to speak with them or ask a question.

When a doctor bills your insurance for a visit, they are forced to submit an itemized list of each and every medical service they provided; the bigger the list, the more they are paid.
These same doctors have to see 25-35 patients a day to keep the lights on, and many times, the cost of billing is more than the fee itself.

Direct primary care is not just a better version of what is already there. Rather, DPC physicians are taking medicine BACK from insurers, administrators and the government by providing truly patient-centered, proactive, accessible & affordable care that is otherwise unavailable in the traditional insurance-based system. DPC allows physicians the freedom to have dialogue with and serve their patients whenever, wherever, and however the patient needs it. By not billing insurance companies, medicine can be practiced as it was meant to be practiced – with doctors spending all of their time with patients. This allows patients to experience better service while having better health – namely fewer surgeries, specialist visits, hospitalizations, and medications. According to Qliance Medical Management, Inc., the use of services rendered outside of a primary care facility drops precipitously once DPC is introduced. Patients enrolled in a DPC program:

  • have 59% fewer ER visits
  • spend 30% fewer days admitted to a hospital
  • are referred to specialists 62% less
  • have 80% fewer surgeries.

I have chosen this membership model going forward because it defines high-value care, finally allowing me to provide unfettered high-quality, safe, highly-satisfying, affordable care to my deserving community.

WHAT ABOUT LABS, IMAGING, AND PRESCRIPTIONS?

The only change is that I’ve partnered with resources that may save you additional money if you would like to pay cash rather than submit to insurance. However, if you still would like to submit to your insurance you are welcome to do so. I can provide you with those options that allow you to make the right decision based on your situation.

Contact

Contact Us Today

Clinic HOURS

Monday-Friday
10am-3pm
After hours and weekend availability by appointment only.

ADDRESS

P.O. Box 2
101 West Loomis Street Suite A
Birchwood, WI 54817