Direct Pay Primary Care – How It Works

Think that you must have insurance to see a primary care physician? Think again! Direct pay primary care has grown in popularity since the mid-2000s and is a great option for those that want to forgo the skyrocketing monthly health insurance premiums and get the basic medical care that they need. 

But how does it work? Not to worry! Our team at Impact Med Sun City has you covered. Here is everything that you need to know about direct pay primary care so you can see if it is right for you. 

What is Direct Pay Primary Care? 

Essentially, direct pay primary care is a financial arrangement made directly between you, the patient, and your healthcare provider. It cuts the insurance company out of the process, getting rid of the need to file health insurance claims or wait for approvals. 

Patients who use direct pay primary care forgo paying for monthly health insurance premiums and copays, and instead, they pay their healthcare provider a monthly fee for their services. 

How Direct Pay Primary Care Works 

The direct pay primary care model gives clinics and family practices an alternative to fee-for-service insurance billing and typically charges patients a monthly, quarterly, or annual fee. This fee covers primary care services that they may receive including clinical and lab services, consults, care coordination, and comprehensive care management. 

Some services are not covered, so direct pay primary care practices often suggest that patients get a high-deductible health insurance policy to cover emergencies.

Why Direct Pay Primary Care? 

The direct pay primary care model benefits patients by providing them with substantial savings and a greater degree of access to their doctors and therapists. It also allows physicians to care for the whole person while reducing the overhead and time-consuming aspects of third-party billing. This means more time spent with you, the patient! 

Benefits of Direct Pay Primary Care 

There are many benefits to direct pay primary care including:

More Time with Your Doctor 

Direct pay primary care doctors can avoid filing insurance paperwork, which allows for in-depth visits and consultations with their patients. They also likely have fewer patients so they can give you true one-on-one attention. This allows them to create a more personalized healthcare plan for you and your family. 

Upfront Pricing 

With traditional health insurance, patients are often left wondering how much their insurance is going to be billed for a procedure or how much they will have to pay out of pocket—until the bill comes in the mail. 

Direct pay primary care eliminates all that confusion. Patients know their exact monthly costs of memberships as well as if they must pay a fee for any visits. 

Convenience 

Often, direct pay primary care clinics offer same-day or next-day visits and even the options to call, email, text, or video-chat with a doctor 24/7. In a traditional health insurance plan, there isn’t this much convenience or access as it would be too difficult to bill. 

Costs and Payment 

The monthly fee for many direct pay primary care services is usually around $100, or more. This fee gives patients unlimited access to their primary care doctor. Keep in mind that some providers will also charge an additional visit fee at the time of services. 

Fees are generally determined by a patient’s age, the kind of practice, and the number of family members on the plan. 

The monthly fee will cover all or most of the typical primary care services that your family may need such as:

• Preventative care
• Lab tests like blood tests or urinalysis
• Care coordination
• Comprehensive care
• Consultations 
• Wellness exams
• Physicals 

It is important to keep in mind that specialist visits, urgent care, and visits to the hospital are not covered in the monthly fee. 

Is Direct Pay Primary Care Worth It? 

Since patients can pay out of pocket and have direct access to their provider at any time, these options can be appealing to a range of people. Families with small children, people who travel often, or elderly patients who aren’t mobile enough to travel to the doctor could greatly benefit from having a direct pay primary care physician. 

However, because direct pay primary care is often paired with a high deductible health insurance plan, they might not be the best choice for people who need more specialized care or who have chronic or complex issues. 

Direct pay primary care is best for patients who are healthy and only need to see their primary care doctor for a routine visit like a wellness exam, or a short-term illness like the flu.  

Choose Direct Pay Primary Care at Impact Med 

If you need primary care for your family, our team at Impact Med Sun City Center is happy to help! We offer direct pay primary care options and take most insurance providers. 

To learn more about our direct pay options call our team at Impact Med Sun City Center today—813-938-5195!