Direct primary care business models and concierge service medical practices are growing trends in today’s society. Many people are tired of having to wait days, sometimes weeks, to see their primary care physician when they are sick or even just need a routine physical. Once you are able to get in, your visit is often hurried and impersonal, taking the facts and moving to the next patient.
With all of the changes in healthcare, direct primary care practices and concierge services are often looked at as a way to get a more personalized doctor experience. While most people think they are the same concept and use the terms interchangeably, they are in fact very different.
How Are They Different?
Concierge medical practices often charge a large monthly fee for access to their program. Their fees can be as high as five thousand dollars annually. This fee gets you personalized services from your doctor, an around-the-clock emergency number, internet-based healthcare for simple questions and diagnoses, longer appointments, and sometimes house calls. Doctors associated with the concierge service typically limit their patients to a few hundred and often do not take on new patients until someone leaves. The biggest difference, however, is that concierge services will bill your insurance for medical visits and charge much higher monthly membership fees than do Direct Primary Care medical practices.
Direct primary care services are a membership based healthcare model. They do not bill your insurance; instead you pay a low monthly membership fee. Typically these fees range from sixty to one hundred and twenty dollars a month. Most DPC medical practices have no co-pays, while concierge services nearly always charge additional fees. They also offer longer, more patient-focused appointments along with telemedicine. Some direct primary care doctors offer house calls, as well, at no additional cost. Practices like Functional Family Medicine follow your care through anything you need. If you need to go to the emergency room or are hospitalized, they are there to help you, in person, because they know your baselines and your health needs.
Why Should You Choose Direct Primary Care?
There are two good reasons for choosing direct primary care over a concierge medical service. The first is if you don’t have insurance or are underinsured. The second is you like to save money.
Since direct primary care practices do not bill insurance companies, they are the perfect option for those who do not have insurance or who have emergency-only coverage, which doesn’t cover everyday health costs. Instead of having to go to a clinic to get treated by a doctor you see once, you have the opportunity to have a relationship with your doctor—someone who knows you and your health history and can treat you accordingly. When something is truly wrong, you want a doctor who is going to be able to really assess your situation, not just offer a quick fix for the time being.
Direct primary care also can save you a lot of money. There is a monthly membership fee, which is considerably less than what concierge practices charge. Functional Family Medicine’s fee is only $59.95 per month. On top of that, you are not at the mercy of what your insurance will or will not cover, so you know right away how much your bill will be. There are no surprise bills or denial letters in the mail a few weeks later.
With a concierge practice, the monthly fees are very high on top of what you are already paying in insurance premiums. They also bill your insurance, so you are still responsible for bills such as deductibles and copays. With today’s insurance regulations, some deductibles can be as high as a few thousand dollars. This means you are paying for your monthly concierge care, your deductible, and any copays or co-insurance associated with your visit. You could literally be paying double, sometimes triple the amount for the same service you could be receiving with a direct primary care doctor. This is one of the reasons concierge medicine has been referred to as healthcare for the wealthy, as your everyday patient cannot afford the fees associated with it.
By taking out the third-party billing aspect all together, direct primary care practices are able to offer better services to their patients. They are not restricted by pre-authorizations or insurance denials, which take manpower to fight and overturn insurance rulings. It takes the guesswork out of diagnosing the problem. The doctor has the ability to treat your issue without tip-toeing around what insurance will cover, giving you better service and a more personalized experience.
In addition, primary care doctors are less likely to refer you out to a specialist if they can handle something themselves. There is no one dictating that a specialist referral is required, which can also save you a considerable amount of money since specialists often charge higher fees for their services.
With the incorporation of telemedicine, your simple healthcare needs can be met with the click of your mouse. Adding the ability to send and receive medical emails via your computer, tablet, or smartphone is another way that direct primary care practices provide better service. While other health entities offer this as well, you are typically getting responses from a team of nurses or doctors whose job it is to answer these questions based on your chart information. These are usually doctors and nurses you have never met, and most likely never will. With direct primary care practices, the limited patient base allows for your team of doctors and nurses to address your healthcare needs not only by your chart, but by knowing you and your health. And the telemedicine is all included in your monthly price!
Although the terms are often erroneously used interchangeably, there is quite a difference in the actual practice of direct primary care and concierge care services. If you want truly hassle-free, affordable healthcare where your best interest is always the number one priority, then you want to enroll with a direct primary care provider for all of your healthcare needs.