Frequently Asked Questions
Direct Primary Care is a growing movement but it is still new. Below are some frequently asked questions to help you decide if DPC is right for you.
Direct Primary Care
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!
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 don't need to worry about prior authorizations or whether our treatment will be approved. 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.
The monthly fee also helps patients to budget for their healthcare needs without concern for co-pays or hidden costs.
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.
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.
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.
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 based in the Christian faith (Liberty HealthShare, Medi-Share, Samaritan Ministries) but some secular organizations (Sedera) are emerging. Most recently we started working with Taro Health, 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?
The best answer is to consult your tax professional. Believe it or not, our government is still trying to decide if DPC service is a qualifed medical expense. When applicable law allows patients to use their HSA funds, we'll be the first ones to shout it from the rooftops! But for now, you can use your HSA for medications, imaging tests, labs, etc.
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.