INSURANCE & PAYMENT
Do you accept insurance?
PureHealth Functional Family Medicine will work with you to help you get paid by your insurance company. We do not have ties with insurance, Medicaid or Medicare in order to give you more time, better care, and lower prices. As we are “out-of-network,” please check with your benefits for payment options if you choose to submit a claim.
Although your membership fee isn’t covered by insurance, you have the option of using your insurance for MRI, prescriptions, labs, etc. or pay a highly-reduced cash rate. If you have private insurance, we’ll give you a receipt with all the information you need to submit a claim form to your insurance company, to get reimbursed directly. The amount of reimbursement you receive will depend on your contract with your insurance company.
We like to say everything done within the walls of or by the practice is covered by our fees. If you need to go outside the office – like for labs, blood work, or specialists you can use insurance like you normally would. Dr. Stock retains his full referral capabilities and can actually offer much-less-expensive cash pricing for those with high deductibles, helping you drastically reduce healthcare costs.
Click here to find out why this model is different.
Why pay directly when I have insurance?
Studies show savings of $260 per patient per month with DPC compared to insurance-based practices. This savings come from reducing ER visits, hospital visits, inappropriate use of techology and referrals. Because you have full access to me, I can be the one to guide you in your healthcare decisions. By joining a DPC practice like mine and having all of your primary care needs covered at all times, you then may have some options to move to an insurance plan that is more catastrophic. I would suggest talking to an insurance professional for your options.
Some Medicare Advantage plans will assign you another physician who will remain inactive in your case. Also Medicare HMO plans DO require in-network primary care doctors. I’m happy to work with them if you want me to.
Especially for Medicare patients, PureHealth Functional Family Medicine will provide health services that are vastly expanded from what you are accustomed to. As a result, you may not need as much Medigap insurance and may be able to drop down to a deductible Medigap plan to save money – especially if your Medigap premium is maxed out. We recommend you contact a Medigap consultant to explore ways to save money. Contact us to get recommendations if you don’t have a Medigap consultant.
Our service contract is for one year. All contracts are automatically renewed unless a 15-day notice is received by us not to renew. You can cancel your membership with 15 day’s notice and any future payments will cease.
Health Savings Accounts (HSAs)
Always check with your tax advisor, but our fees are designed to be compliant with health savings, flexible spending, and health reimbursement accounts. We are happy to provide you with an invoice and/or submit a notice to your employer if any questions arise about our programs. While a membership is a qualified medical expense, we do recommend paying with an HSA.
You may pay with cash, credit, or check. For convenience, we keep a credit card or bank account on file for incidentals and to make it easier for you to make payments.
If I sign up today, when would I get charged?
If you sign up for a reduced-hourly-rate membership online, you will be charged immediately. Hourly rates are due at the time of service, but are calculated to the nearest 5 minutes and only on the time doing medical thought, not administrative duties.
Our practice is excellent for the patient with Medicare who wants more care and services beyond what the the government desires. Our Medicare patients pay our practice fees directly, but Medicare coverage remains in place for everything else: specialists, testing performed outside our office and hospitalizations. Your Medicare also covers labs services, as these are performed by an independent lab affiliate. While I don’t accept Medicare payments, I can refer, write orders and prescriptions, and act as your primary care physician, and Medicare will pay for any services that I order, just like they would for a Medicare-accepting provider.
Some Medicare Advantage plans will assign you another physician. Medicare HMO plans DO require in-network primary care doctors. I’m happy to work with any of them if you want me to.
Especially for Medicare patients, PureHealth Functional Family Medicine will provide advice that is vastly expanded from what you are used to in primary care. You may not need as much insurance or may be able to drop down to a deductible medigap plan to save money, especially if your medigap is maxed out. We recommend you contact a healthcare consultant to explore ways to save money. Contact us to get recommendations if you don’t have a medigap consultant.
SERVICE & HOSPITALIZATION
If you feel you need to go the hospital, please call and discuss with me at any time. As your private physician, I would like to be involved in your hospital care—whether to speak to the emergency room physician or the in-patient doctor to assist in your care. I am also happy to keep in touch with your families during your stay and help arrange for your care after you return home.
What about labs, imaging, 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. For example, I’ve partnered with multiple vendors for labs for dramatically lower, cash-based pricing. 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.
What if I go to a hospital?
I became an independent family physician to make you the priority. That means we would like to be your healthcare advocate out of our office. It is best to contact me before you go to an ER, hospital, or specialist. I can work with your other doctors to make sure you get the care you need.
SCHEDULING & COMMUNICATION
My practice uses technology that allows me to be available to you after-hours. You will have access to communication tools that will allow us to securely text, video chat, and send pictures in real time. While I cannot provide emergency care after hours, I can help you decide whether you want or need emergency care. My technology allows you to contact me after hours so we can talk about your concerns.
How are office visits handled?
It’s easy! Request a visit either online or by phone and come in to the office and see me. You and I also have the option to conduct a tele-visit as an alternative for a quick checkup or acute visit.
How can I be sure you will have time for me if your access is unlimited?
I am not the first practice to be structured using this model of care. My practice is designed to be viable at about 600 patients. Keep in mind that a normal practice has roughly 2000 patients-per-doctor. My main priority is you, and I want to make sure I’m available for you while maintaining little-to-no wait, same-day or next-day visits, as well as office visits that are not rushed. And remember, if I tried to take on too many patients, they would start cancelling their memberships, just like you can.
DIRECT PRIMARY CARE
Why is direct patient care better?
Conventional insurance-based medical practices are unwieldy, with many more employees and time spent just on billing and collections. Because of this, doctors are forced to see 35+ patients a day, allowing little time for each visit and creating wait times many times over an hour. Many times, the cost of sending the bill to six different places is more than the fee itself. By letting doctors be doctors, and not business centers, the cost of an office visit goes way down. Even more importantly, insurers, employers and government programs pay doctors to give the advice they want you to have, and financially punish them for giving advice they don’t want you to have. By working directly for you, my advice is not coerced by these sources.
Do you have evidence that direct primary care 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. Less paperwork for doctors means more time to spend with patients as needed to manage medical conditions. More time means more access and more thought, which means fewer specialist referrals, hospital admissions and ER visits. In insurance-based medical clinics, 43% of the day is spent on needless paperwork.
Will you allow to me to see you without signing up for a full membership?
Yes. I’m just a brain you rent to get detailed, unbiased advice from. Memberships allow you to rent in bulk, and you get hourly-rate discounts for that. But if you think you aren’t going to need much advice in a year, I’ll still see you for an hourly rate of $300.00/hour. This will still save you money over going to an urgent care or doctor who is paid through insurance, if you are healthy and have a laceration, ankle sprain or acute infection. I would always suggest you talk to me directly and we can together figure out a plan that makes sense to you.