Frequently Asked Questions

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What is direct primary care (DPC)?

· DPC is a health care delivery model that provides an opportunity for patients and physicians to enter a relationship that puts the patient first. By providing primary care services for a low, flat monthly fee, patients get same-day or next-day visits without co-pays. With direct access to the physician, patients can also contact their doctor by phone, secure text, email, or video chat when care is needed. DPC offers unhurried office visits, access to discounts on medications, labs, pathology, and imaging, all without the need for insurance. By removing the insurance red tape we are able to keep our prices affordable.

Is Direct Primary Care the same as concierge medicine?

·  Concierge medicine and Direct Primary Care are often used interchangeably but there may be significant differences depending on the practice. Both concierge and DPC limit patient panel size and charge a monthly or annual fee, but concierge fees are usually higher, sometimes up to $30,000 a year. Another significant difference is that concierge medicine often continues to charge co-pays for each visit and bill insurance. DPC is a model based on a direct relationship between the physician and the patient, bypassing insurance to reduce costs, making it more affordable for patients. There are no co-pays, deductibles or hidden charges at Central Illinois Direct Care

Is DPC insurance?

· No, DPC is not insurance.  The monthly service fee is your payment for ongoing primary care services offered by your physician. We strongly recommend that patients do have insurance for care that may be needed beyond what we offer (specialty care, ER or hospitalization, surgery, etc.). Direct primary care works well with a high deductible “wrap around” or “catastrophic” policy.

Do you take my insurance?

· No, we do not accept or bill health insurance. In the DPC model, we contract directly with the patient, not an insurance company. By eliminating the restrictions and frustrations associated with health insurance, we keep costs low and spend as much time as needed with our patients. Insurance can be helpful in catastrophic situations, and we recommend that you do have insurance for emergencies, but you will find that much of the care you receive through Central Illinois Direct Care costs less than it would if you use your insurance.

If I have insurance can I use it?

· If you use Central Illinois Direct Care for your primary care, we will strive to keep you healthy and reduce the need for specialty referrals and hospitalizations, but there may be times that you will still need your insurance for specialty care, surgery, or hospitalizations. Central Illinois Direct Care is considered an “out of network” provider but most insurances, except HMO policies, will still cover tests, consultations and procedures ordered by out of network providers.

If I have Medicare, can I still become a patient at Central Illinois Direct Care?

· Absolutely! You will need to sign a one-time waiver declaring that neither you nor my office will directly bill Medicare for our services. You can continue to use Medicare for laboratory testing, imaging, and medications prescribed by our office, as well as specialty care and hospitalizations. You may even find that you will save money on your primary care, labs and medications through our discounted pricing.

Can I use an HSA to pay my Central Illinois Direct Care fees?

 President Trump signed a historic health care executive order in June. It supports direct primary care (DPC) practice models and promises to make health care prices more transparent than they have been in a half century. One of the executive order’s biggest changes, however, is allowing patients to use tax-advantaged health savings accounts (HSAs) to pay for DPC services. “Within 180 days of the date of this order, the Secretary of the Treasury, to the extent consistent with law, shall propose regulations to treat expenses related to certain types of arrangements, potentially including direct primary care arrangements and healthcare sharing ministries, as eligible medical expenses under section 213(d) of title 26, United States Code.”  Eligible medical expenses are considered tax deductible and many insurance companies will apply your expenses to your insurance deductible! 

What happens if I need to be hospitalized?

With virtually unlimited access to your doctor, and the ability to have a much closer working relationship with your doctor our goal is to prevent or reduce hospitalizations. We do not provide inpatient hospital care. When hospitalization is necessary we will collaborate with the hospitalist during your hospital stay. We are able, however to make social visits to our hospitalized patients and these are included in your membership.

What if I need medical care while I’m traveling?

· This is one of the benefits of being a patient of Coastal DPC—because we know you well, we can usually care for you even when you’re away from home. Many illnesses can be diagnosed and treated by communication through by phone, secure text, email, or webcam. If necessary and appropriate, we can call prescriptions into the pharmacy nearest you.

Will I have access to my medical records?

· Our electronic medical record offers you access to your medical chart through a patient portal. Your records are your property so you should be able to access them at your convenience and download them for free.

Do you share any medical records with insurance carriers or pharmaceutical companies?

· No, unless you specifically request it. We take your privacy seriously, and we are not obligated to provide any third party with a copy of your records unless you specifically ask that we do and sign a release of records. In DPC, we contract directly with you!

What if I’m not satisfied?

· We care about your experience and your satisfaction, and we continually strive to improve. If you are not satisfied for any reason, please let us know so we can work to resolve any problems. Open, honest communication is vital to our continued success and we want to hear from you. We also welcome compliments!

How long is the contract?

· Central Illinois Direct Care operates on a monthly billing basis. There are no long-term contracts, so you may terminate your patient-physician relationship at any time. But we hope you don’t—please talk to us! 

What is your policy on controlled substances?

· We believe that controlled substances, both narcotics (Lorcet, Lortab, Norco, Oxycontin, Percocet, Vicodin, etc.) and benzodiazepines (Ativan, Klonopin, Valium, Xanax, etc), have a limited role in primary care and therefore these medications are rarely prescribed. We believe chronic pain requiring narcotics is best managed by a pain management specialist, but we are happy to work with you on non-narcotic options for your pain and to manage your other medical conditions. We do not treat anxiety with benzodiazepines, but offer other medications and techniques often successful in treating anxiety. No controlled substances are kept in the office.

If I enroll as a patient of Central Illinois Direct Care, when does billing begin?

·  Your monthly billing will start on the day of your first visit with the doctor. Please note that care cannot be provided prior to an initial intake physical exam.