Frequently asked questions
- What is Direct Primary Care and how does it work?
- Why is ProPartnersMD changing?
- Why is ProPartnersMD dropping my insurance?
- Will you still file my insurance for me?
- Can I file my own insurance claim for services I receive as a Direct Care Member?
- Can I still be a member if I have regular insurance or Medicare?
- Does becoming a member affect my insurance coverage with other medical groups or facilities?
- Will my insurance company honor referrals, tests, and procedures ordered by my ProPartners “out-of-network” physician?
- How does Direct Primary Care work with healthcare reform and the Affordable Care Act?
- How do I enroll?
- Is there an enrollment fee?
- Can I just wait to join until I need something?
- What if I want to cancel my membership?
- What forms of payment do you accept?
- Will my monthly fee change?
- May I pay my monthly fee with my HSA/HRA/FSA?
- Are my membership fees tax-deductible?
- What services are covered by my monthly fee?
- Are Milestone Health Assessments included with my membership?
- Are there any services that cost me money beyond my monthly membership fee?
- What if I need to be seen frequently for a chronic medical problem?
- How do I schedule an appointment?
- Who decides when I can be treated over the phone?
- Are visits with my doctor unlimited?
- How do I reach my doctor after regular office hours?
- How else can I communicate with my doctor?
- What if my doctor is on vacation or unavailable when I want to be seen?
- Can you admit me to the hospital?
- What if I have other questions?
What is Direct Primary Care and how does it work?
It’s an agreement between you and your doctor. We agree to take care of all your basic and preventive medical care for a flat monthly fee. You receive unrestricted access to all the services we directly provide, as often as you need them. Back to top
Why is ProPartnersMD changing?
We have been listening to our patients! Our patients like being seen the same day or the next for urgent medical care. Their time is valuable, and they want to avoid the inconvenience of leaving work and driving to our office when a phone call or email would suffice. When they do come in, they want unpressured time with the doctor to address all their concerns. Direct Primary Care is the only model that can allow us to provide this level of personal service. Back to top
Why is ProPartnersMD dropping my insurance?
Direct care works because it eliminates the expenses and constraints that come with insurance participation. It’s estimated that as much as 30 cents of every dollar you pay for primary healthcare is absorbed by the relationship between your doctor, your insurance company, and you. By paying ProPartners directly, your care is affordable, our overhead is lower, and we can limit the number of patients that each of our doctors take care of — so we’re much more available when you need us. Back to top
Will you still file my insurance for me?
No. As a Direct Care Member, you will pay our practice directly for all services and we will not file insurance claims on your behalf. Back to top
Can I file my own insurance claim for services I receive as a Direct Care Member?
No. As a Direct Care Member, you will agree NOT to file insurance claims for services you receive through our office (if your doctor is a participating provider with your insurance plan). Even if your doctor is not participating with your insurance plan, you should not expect to be reimbursed by your health insurance plan for services received at ProPartners. Back to top
Can I still be a member if I have regular insurance or Medicare?
Yes. Most of our members will have some type of traditional insurance. We strongly encourage you to maintain health insurance to cover expensive and unpredictable medical services like hospitalizations, surgeries, and specialists’ care. Back to top
Does becoming a member affect my insurance coverage with other medical groups or facilities?
No. You can continue to utilize your health insurance with participating providers as you always have. These providers will bill your insurance in the same way that they always have. Back to top
Will my insurance company honor referrals, tests, and procedures ordered by my ProPartners “out-of-network” physician?
Yes. In the event that you need a referral to a specialist or diagnostic service outside of our office, we will attempt to refer you to providers that participate with your insurance. Orders for lab tests, CT scans, MRI scans, and referrals to specialists are generally honored and covered by health insurance when ordered by ProPartners (out-of-network) physicians. If you have a plan that does not, your doctor will refer you to a specialist or “gate-keeper” physician that is acceptable to your insurance for any specialized tests or specialist’s care that you may require. Back to top
How does Direct Primary Care work with healthcare reform and the Affordable Care Act?
Direct Primary Care is specifically described in the Affordable Care Act and, when combined with a high-deductible “wrap-around” insurance plan, meets the “individual mandate” for health insurance coverage. Back to top
Is there an enrollment fee?
Yes. There is a $60 one-time initiation fee payable at the time you agree to become a Direct Care Member. Your monthly membership fee will be charged to your credit card of choice. Back to top
Can I just wait to join until I need something?
We don’t recommend it. We are currently enrolling members and expect to fill our patient lists or “panels” quickly. If you wait, you run the risk that your preferred doctor may not have any membership openings or that all of our physicians might be full. Back to top
What if I want to cancel my membership?
No problem. If for any reason you are not completely satisfied with our care, you may cancel your membership after the first 90 days with no penalty. You would simply need to notify ProPartners in writing 30 days prior to your intended termination date. Back to top
What forms of payment do you accept?
Currently, all membership fees are accepted via automatic monthly charges to your credit card of choice. We accept Visa, Master Card, American Express, and Discover. Back to top
Will my monthly fee change?
Membership fees are charged according to your age. If you “graduate” to the next age tier, your monthly credit card charge will automatically increase the month following your birthday. Like most things in life, it is possible that our prices may increase over time. We promise they will increase only modestly and will never increase more than once a year. Back to top
May I pay my monthly fee with my HSA/HRA/FSA?
Some of our members have chosen to pay their membership fees directly from their health savings account (HSA) or flexible spending account (FSA). Accounts that only reimburse for expenses previously denied by insurance, such as a health reimbursement account (HRA), are generally not eligible. We recommend checking with your tax adviser, employer and/or health insurance representative to determine if your particular account may be used. Back to top
Are my membership fees tax-deductible?
Unfortunately, no. Direct Primary Care membership fees are not yet defined as a “medical expenses” in most states and are not tax-deductible. We recommend that you discuss this further with your tax adviser or accountant. Back to top
What services are covered by my monthly fee?
Direct Care Members enjoy high-level unrestricted access to all Member Services in our office. This includes unlimited office visits, “virtual” visits with the doctor by phone or email, after hours access to a doctor, and all diagnostic tests and treatments that can be performed at ProPartners. For a more thorough description, CLICK HERE. Back to top
Are there any services at ProPartners that cost me money beyond my monthly membership fee?
- Lab tests that are ordered from outside labs are offered to Direct Care Members at our cost. This is generally about 10% of retail and less than 30% of what you might have to pay when utilizing your health insurance. One advantage of membership is transparent pricing of services and control of costs by you. We will always tell you the cost of lab tests before they are performed.
- Other services that are not available at all ProPartners locations are billed at a heavily discounted or "at cost" price. These services currently include: Milestone Health Assessments, treadmill exercise EKG, Pro-Fit 60, metabolic testing, personal fitness trainer consultation, registered dietitian/diabetes educator consultation. Back to top
What if I need to be seen frequently for a chronic medical problem?
No problem. ProPartners provides management of all common chronic conditions such as diabetes, hyperlipidemia, and low testosterone. You will be able to see your physician as often as needed, without any additional charges. Many visits to our office may be avoided altogether, when your physician determines that your situation can be handled by email or telephone. Back to top
How do I schedule an appointment?
Very easily. Just call, email, or submit an online appointment request and your appointment will be scheduled right away. In the future, we plan to offer direct online scheduling so you can choose and book your own appointments directly on your doctor’s appointment schedule. Back to top
Who decides when I can be treated over the phone?
Your doctor does. In most cases, patients and physicians both prefer to manage care efficiently over the phone or by email. If your doctor believes that it is safe to do so, and that he can provide high-quality care, he will save you a trip to our office. He will require an in-person office visit if he feels it is important. Of course, you are always welcome to request an office visit any time that you like. (Our office staff have guidelines for offering “virtual” visits and will offer to schedule them when appropriate.) Back to top
Are visits with my doctor unlimited?
You may schedule an appointment whenever you need it, as often as you feel the need, and you may decide how much time you need with your doctor. You may schedule appointments for up to one hour. Back to top
How do I reach my doctor after regular office hours?
Every Direct Care Member is given a direct-dial access number that rings to their doctor’s cell phone when our office is closed. Your doctor wants you to be able to reach him at all times with urgent medical problems, should they arise. Back to top
How else can I communicate with my doctor?
Email is a very efficient way to communicate with your doctor in many situations. Members have access to several email addresses to send messages directly to their doctor and his staff. Keep in mind that while you may choose to share your personal information over email, this method of communication is UNSECURE. In the near future, our online patient portal will allow 2-way, fully SECURE communication. Your doctor will always send electronic communications to you via the patient portal. Regardless of which of these methods you use, you can expect a response back the same day to all communications submitted during our regular office hours. Back to top
What if my doctor is on vacation or unavailable when I want to be seen?
Your doctor will generally be accessible to you 24/7. If you need to be seen in the office, you will be able to get an appointment the same day or the next. In the rare event that your doctor is unavailable, one of our other physicians will provide care and will have full access to your electronic medical record. Our doctors do occasionally take a vacation. If they are “off the grid,” you will have access to one of our other doctors 24/7, and your direct-dial number for your doctor will ring to the alternate physician. Back to top
Can you admit me to the hospital?
No. If you need to be hospitalized, you will be admitted by an internal medicine hospitalist who participates with your health insurance. Your ProPartners physician will be kept informed about your care and will follow up with you after you are sent home. Back to top
What if I have other questions?
If you can’t find the answers to your questions on this website, we would be happy to talk with you in person. Just calland ask for a Direct Primary Care Specialist. You may also email email@example.com, if you prefer.