Frequently Asked Questions

What is Direct Primary Care?

Direct primary care (DPC) is an innovative alternative payment model that improves access to high-functioning health care with a simple, flat, affordable membership fee. No fee-for-service payments. No third-party billing. The defining element of DPC is an enduring and trusting relationship between a patient and his or her primary care physician. Patients have extraordinary access to a physician of their choice who is held accountable to them, not to an insurance company. DPC is embraced by health policymakers on the left and right and creates happy patients and happy doctors all over the country!

What towns do you serve?

Located in Freeport, Maine, we service southern Maine as well as patients throughout Maine through inperson and telehealth care.  We are happy to care for all Mainers and we have patients from as south as Kennebunk and as far north as Rockport.

Why do you charge a monthly fee?

Charging a monthly fee allows us to be creative with our care and attentive to our patients. By removing the insurance companies as payer, we can limit the role of insurance coverage when considering what is best for our patients. Primary care is extremely valuable, but it doesn't need to be expensive. This model allows us to keep a minimalist office and prevents you from being bounced among multiple people before you can actually speak with your physician. We don't need to rush you through your visit in order to see more people, because that's now how we operate. All patients get the time they need. We work for you.

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The monthly fee also helps patients to budget for their healthcare needs without concern for co-pays or hidden costs.

Are there other DPCs in Maine?

Yes!  The DPC movement is growing at a rapid pace throughout Maine and across the country as more Americans look for affordable healthcare.  Fulcrum works alongside several other DPCS in Maine and is involved with the New England Regional Direct Primary Association (NERDPCA) as well as the nationally with the Direct Primary Care Alliance (DPCA)

Do I need insurance to be seen at Fulcrum?

Direct primary care is not insurance, and we encourage all members to carry a catastrophic insurance plan to cover any costs of unexpected critical illnesses or accidents requiring hospital care. Our membership covers outpatient visits, access to the physician and specific services. If you need to be admitted to the hospital, we may visit you to help coordinate care, but our membership will not cover the cost of your stay or the care from the inpatient team.

Being a member keeps down out-of-pocket costs (such as charges applied before you meet your deductible). This allows you to purchase less expensive insurance, while enjoying superior, direct and personalized care from a primary care physician. We offer deeply discounted lab testing and medications at wholesale cost, but you may also use your insurance for these services if you would like.

We don't bill insurance for our services, so we are not bound by industry rules or restrictions. Dr. Lucas will see any patient who is interested in receiving personalized medical care, including uninsured patients and those with preexisting conditions.

Do I need to sign a contract?

We do not require members to sign any contracts that commit them to a certain period of membership. Memberships do not have an end date. We do ask patients to sign a patient agreement to help define our relationship and ensure we understand how best to work together.

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A minimum of the first month of membership and a registration fee are paid up front and are nonrefundable. If you decide to cancel and have a balance of prepaid membership fees remaining, a prorated refund will be given to you based upon the date of cancellation. We ask for 30 days notice prior to cancellation.

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We would love the opportunity to take care of you and your family for many years to come, but if you change your mind, you are welcome to cancel at any time. Please note, we do charge a reenrollment fee of $150 if you should choose to return to Fulcrum Family Health after a cancellation of membership.

Why would I pay extra money if I have insurance?

Direct primary care is an alternative and better model for primary care. We don't believe it makes sense to use a fee-for-service model for primary care. Physicians who practice primary care in an insurance-based model are forced to see many patients at shorter intervals to cover a multitude of costs (not the least of which are staff, time and material, in effort to comply with health insurance payment criteria) . If your insurance covers primary care, you are paying for an expensive benefit that is often difficult, if not impossible, to enjoy.

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Direct primary care is comprehensive, highly effective and less expensive than the current insurance-based primary care model. And with access to cash-based prices for labs/imaging and wholesale medication, patients can save hundreds of dollars per month. DPC is best paired with a catastrophic insurance plan for unexpected events.

I'm uninsured. Can Fulcrum Family Health help me figure out how to get insurance coverage?

If you are interested in pairing DPC with catastrophic coverage, we are here to help you. We can advise you on affordable, high-deductible plans or health care sharing ministries. Traditionally, these health sharing ministries are based in the Christian faith (Liberty HealthShare, Medi-Share, Samaritan Ministries) but some secular organizations (Sedera) are emerging. Most recently we started working with Mending insurance, the first insurance to partner with DPC as their primary care option!  Stop in to speak with us about your coverage options and capabilities.

Can I use my HSA to pay for the DPC monthly fee?

UPDATE: As of January 2026, DPC is qualified as a medical expense (and not insurance) and is HSA eligible.  See here for more information.  This is great news!  There are some limitations specifically on eligible amount.  Patients can allocate $150/person and $300/family.  Patients are advised to keep records and discuss details with their accountants.  We will ask to use another form of payment in our system if your cost is above the eligible amount and then reimburse yourself from your HSA funds as you see fit.  

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This price limit does not limit your use of HSA funds for other Fulcrum offerings like labs, procedures or metabolic health programs.  It only limits the DPC membership reimbursement.

How is this different from concierge medicine?

Concierge practices charge patients a monthly fee in addition to charging insurance. Therefore, they still must work within the insurance model, which may limit or change therapies depending on insurance approval. Concierge practices improve access to the physician but don't achieve the goal of decreasing the cost. We strive to deliver this superior service to patients with or without insurance and at any income level.

Does Fulcrum accept Medicare patients?

Yes, Fulcrum accepts Medicare patients.  At this time, only Drs. Lucas and Batz can accept Medicare patients to their panels.  Medicare requires DPC physicians to opt-out of Medicare in order to work with Medicare patients in the monthly membership model.  This is because Medicare technically covers primary care services.  We believe a monthly membership model is a better way to care for patients so we will ask you to sign a form at our office to acknowledge that you understand you can obtain theses services elsewhere with a physician that takes Medicare. 

We discourage the use of Medicare Advantage plans as they are more restricted and act like a HMO (see above.  We believe patients have better access to care with traditional Medicare and a supplemental plan.    

Do you treat kids?

Absolutely!  We love taking care of families.  We take care of patients from newborn to seniors.  We have vaccines in our office and follow evidence-based guidelines of care.  In DPC, we schedule longer visits which we find helpful when it comes to discussions of care.  Families feel they have the time to ask questions about medications, vaccines and complementary approaches to care.  We believe in shared decision making.  

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We will care for patients that are unvaccinated because we believe everyone has the right to care. With that, we will ask unvaccinated patients to utilize masking when ill and to call the office before coming into our space. This is to ensure we can screen for reemerging infectious illnesses like measles.  

Do you prescribe GLP1 medications like semaglutide and tirzepatide?

Yes!  We have a board-certified obesity specialist in the practice so this is a commonly utilized medication in our practice.  We approach obesity and metabolic syndrome from a medical perspective and consider treatment to improve cardiometabolic risk.  We also utilize GLP1 medication for patients with joint pain, endometriosis and other inflammatory states.

Do you offer chronic opioid therapy?

At this time, we do not have the setup to provide ongoing opioid treatment to patients. We believe this type of care must incorporate behavior health and more structured monitoring.