Direct Primary Care Medical Providers

[daisylu]

Anyone have experience with direct primary care?

I live in an area that has grown tremendously in the last 20 years, but has not kept up with infrastructure. It is severely lacking in medical care, as in there are no medical practices within 50 miles accepting new patients. These people end up clogging up the hospital, yes 1, and urgent cares with issues that should be addressed by a PCP.

DH needs a new doctor. The practice he is currently with has become hard to contact and want to schedule everything at least 3 months out, which is not acceptable when you are sick. The one I used was recently taken over by the system that runs the hospital and urgent cares in the area, which do not impress me much, and I was losing faith in them after my last PCP left.

I have been looking at a direct primary care provider as a possible solution. This one has a $75/month fee that covers all visits, which are not billed to insurance. Labs and other stuff are, just not the office visits. They specify that they are different from concierge. And they make house calls within a certain area, another thing I would have to get clarified, but that's not really important for us. From people who have used them, they seem pretty solid and are easy to get same or next day appointments with.

Our insurance plan is very low cost with high deductible, which we rarely ever meet - and I am thankful for that. I would need to contact our HSA to see if the fee is an acceptable charge, but we mostly self pay anyway and consider the HSA as a savings account for future use.

Just wondering if anyone here had experience with such a plan.

[finnime]

I have no experience with this type of plan, but on the surface it sounds promising to me. I've worked with dozens of physicians over the years. One of the biggest universal challenges they contend with is the naked pressure of insurance to see more and more patients. They can't afford to spend time they'd like with patients. The monthly fee would help a lot to alleviate that pressure.

Also, I believe you and your DH are what I would consider pretty young, well before Medicare age. So that's not an obstacle for you. The direct plan would suit your current insurance coverage pretty well. And, you don't really have good alternatives. For me, I'd go for it.

[CCL]

Do you and hubby have chronic conditions you need to be seen frequently for? Is that $75 each or for both? How do they handle specialist visits? I'm guessing those would be completely separate.

My doc is difficult to get an appointment with on short notice. What good does that do me? When we are sick we just go to urgent care and pay the $50 copay.

Our specialists aren't like this. They get us in and take care of us.

If you need seen fairly often the new plan sounds good. If you only get sick once a year, urgent care might be better.

[daisylu]

I am 47 and Dh is 43. I have no health issues. DH does have specialists that he sees for a couple of chronic issues - none of these are impacted by the PCP. With our insurance we do not need referrals so that would be separate. 

I know we will have different needs in the future, but looking at this as a stop-gap to get us there.

The fee is per person. With our insurance, 1 trip to urgent care currently equals 3 months of the fee. DH ends up there a couple of times a year because he has sinus issues - probably 3-4x/year.

Dh does not currently have a PCP, and with the way the area has grown no one within 50 miles is accepting new patients. This is a major issue for us.

A driving factor for me is that DH has had issues with PCPs in the past with being seen timely so he gives up on them, leaving urgent care as his only option. He also hates "wasting" money and will wait until he is almost incapacitated (which takes A LOT) before he will take action. I think if he knows $75 a month will cover anything other than labs & diagnostic, he will be more prone to act on minor illnesses before they become major. Him getting timely care is my main concern at this point, and I think this could encourage him to be more proactive.

Also, he seems to pick up every illness that comes along now, because he is constantly stroking his beard, which includes wiping mustache hair from his lips. We had a very heated discussion about this over the weekend.

[seriousthistime]

When I lived in my current location the first time, I could choose a PCP and see specialists without a referral.  The ease of seeing specialists was because I was not on the HMO.  But making an appointment was sometimes difficult and I'd have to call back because they were not yet scheduling that far out (3 months or more). 

Then I moved to SoCal.  What a difference!  I'd call for an appointment and there would be a very apologetic voice on the phone saying they were sorry, but they didn't have any openings for 10 days. My doc also did shifts in the attached Urgent Care and I was told if I needed to see someone on short notice and she didn't have any openings, to go to Urgent Care and I might even see my own doc. 

(My DS and DDIL lived a few hours from my current location then moved to NorCal and had the same experience.  My DDIL is at high risk for melanoma and needs to see a derm frequently.  Being able to get appointments quickly was like heaven to her.) 

Now I am back to my former location and I have to beg, borrow, or steal to get an appointment.  There is a residency program for adult medicine here and can get in there rather quickly. And my assigned resident is fine and there is really good oversight/teaching of the residents.  But if I stick with the MDs in the residency program, I'll be assigned a new doctor every few years.  Trying to get established with one of the permanent docs who accepts new patients is proving to be difficult.  No openings for at least 3 months, and call back to try to get an appointment beyond then.  

Frustrating. 

[bookkeeper]

Nov 28, 2022 9:14:11 GMT -5 daisylu said:

I am 47 and Dh is 43. I have no health issues. DH does have specialists that he sees for a couple of chronic issues - none of these are impacted by the PCP. With our insurance we do not need referrals so that would be separate. 

I know we will have different needs in the future, but looking at this as a stop-gap to get us there.

The fee is per person. With our insurance, 1 trip to urgent care currently equals 3 months of the fee. DH ends up there a couple of times a year because he has sinus issues - probably 3-4x/year.

Dh does not currently have a PCP, and with the way the area has grown no one within 50 miles is accepting new patients. This is a major issue for us.

A driving factor for me is that DH has had issues with PCPs in the past with being seen timely so he gives up on them, leaving urgent care as his only option. He also hates "wasting" money and will wait until he is almost incapacitated (which takes A LOT) before he will take action. I think if he knows $75 a month will cover anything other than labs & diagnostic, he will be more prone to act on minor illnesses before they become major. Him getting timely care is my main concern at this point, and I think this could encourage him to be more proactive.

Also, he seems to pick up every illness that comes along now, because he is constantly stroking his beard, which includes wiping mustache hair from his lips. We had a very heated discussion about this over the weekend.

I remember when our sons grew out their beards as adults.  The older one told the younger one to stop stroking his beard, it is not a pet.  New beards seem to do well with some conditioner.  The boys in our family like the Cremo brand.  If his beard is softer and not so itchy, maybe he will leave it alone.  Does he have a beard trimmer, like a small clippers, to keep it trimmed from his mouth?

I agree that you must keep your hands from your face if you want to avoid illness.  I had acne as a teen, and had to learn that lesson quickly.  DH was in the habit of putting his hands near his lips as Covid began.  At one point, I told him he was going to be gone because of his own carelessness.  That seemed to get the message through.

DH is 63 and I am 58.  Our sinus trouble started when we were about your age.  Who knew allergies get worse as you age?  We both take antihistamines.  The best solution has been an adjustable base for our bed.  We sleep with the head inclined and both have improved sinus drainage and less snoring.

[daisylu]

Nov 28, 2022 9:52:18 GMT -5 bookkeeper said:

Nov 28, 2022 9:14:11 GMT -5 daisylu said:

I am 47 and Dh is 43. I have no health issues. DH does have specialists that he sees for a couple of chronic issues - none of these are impacted by the PCP. With our insurance we do not need referrals so that would be separate. 

I know we will have different needs in the future, but looking at this as a stop-gap to get us there.

The fee is per person. With our insurance, 1 trip to urgent care currently equals 3 months of the fee. DH ends up there a couple of times a year because he has sinus issues - probably 3-4x/year.

Dh does not currently have a PCP, and with the way the area has grown no one within 50 miles is accepting new patients. This is a major issue for us.

A driving factor for me is that DH has had issues with PCPs in the past with being seen timely so he gives up on them, leaving urgent care as his only option. He also hates "wasting" money and will wait until he is almost incapacitated (which takes A LOT) before he will take action. I think if he knows $75 a month will cover anything other than labs & diagnostic, he will be more prone to act on minor illnesses before they become major. Him getting timely care is my main concern at this point, and I think this could encourage him to be more proactive.

Also, he seems to pick up every illness that comes along now, because he is constantly stroking his beard, which includes wiping mustache hair from his lips. We had a very heated discussion about this over the weekend.

I remember when our sons grew out their beards as adults.  The older one told the younger one to stop stroking his beard, it is not a pet.  New beards seem to do well with some conditioner.  The boys in our family like the Cremo brand.  If his beard is softer and not so itchy, maybe he will leave it alone.  Does he have a beard trimmer, like a small clippers, to keep it trimmed from his mouth?

I agree that you must keep your hands from your face if you want to avoid illness.  I had acne as a teen, and had to learn that lesson quickly.  DH was in the habit of putting his hands near his lips as Covid began.  At one point, I told him he was going to be gone because of his own carelessness.  That seemed to get the message through.

DH is 63 and I am 58.  Our sinus trouble started when we were about your age.  Who knew allergies get worse as you age?  We both take antihistamines.  The best solution has been an adjustable base for our bed.  We sleep with the head inclined and both have improved sinus drainage and less snoring.

Thanks for the suggestion, but his beard is quite soft. It more of a tick  or habit than anything.

[The Walk of the Penguin Mich]

No, but we are experiencing something similarly.  I still have a PCP, TD lost the 5th PCP he has had since I moved out here.  My PCP is not accepting new patients, but he will take TD, only because we are married.  I am totally unimpressed with the local system and my PCP does not inspire a lot of confidence, but so far I have not needed much more than keeping track of my thyroid and my BP has continued to be under control.  My more specialized care is done in Seattle.  

It’s the pits driving 100 miles to see a doctor, but I have seen the absolutely lousy treatment given locally.  It’s a drawback to living here.

[daisylu]

Nov 28, 2022 13:24:32 GMT -5 The Walk of the Penguin Mich said:

No, but we are experiencing something similarly.  I still have a PCP, TD lost the 5th PCP he has had since I moved out here.  My PCP is not accepting new patients, but he will take TD, only because we are married.  I am totally unimpressed with the local system and my PCP does not inspire a lot of confidence, but so far I have not needed much more than keeping track of my thyroid and my BP has continued to be under control.  My more specialized care is done in Seattle.  

It’s the pits driving 100 miles to see a doctor, but I have seen the absolutely lousy treatment given locally.  It’s a drawback to living here.

That is also part of my concern. If we end up having to go that far I will never be able to get DH to see a regular doctor.

[The Walk of the Penguin Mich]

Nov 28, 2022 14:25:59 GMT -5 daisylu said:

Nov 28, 2022 13:24:32 GMT -5 The Walk of the Penguin Mich said:

No, but we are experiencing something similarly.  I still have a PCP, TD lost the 5th PCP he has had since I moved out here.  My PCP is not accepting new patients, but he will take TD, only because we are married.  I am totally unimpressed with the local system and my PCP does not inspire a lot of confidence, but so far I have not needed much more than keeping track of my thyroid and my BP has continued to be under control.  My more specialized care is done in Seattle.  

It’s the pits driving 100 miles to see a doctor, but I have seen the absolutely lousy treatment given locally.  It’s a drawback to living here.

That is also part of my concern. If we end up having to go that far I will never be able to get DH to see a regular doctor.

TBH, it is easy when I only need to see them once/year or less.  Getting a PCP that far away is another issue.

Seeing a friend who was under a pulmonologist’s and cardiologist’s care for 8 months being treated for pneumonia when he had stage 4 lung cancer undiagnosed until he went on a ventilator doesn’t inspire a lot of confidence in the local system.

[susana1954]

I have a former colleague who decided to go to medical school in her 40s.  This is how she decided to practice.

It is designed primarily for insurance similar to yours.  You will only meet your deductible if you have what would basically be a catastrophic illness.  I have no idea if you get negotiated rates on labs, etc.  Her website says they contract with the most reasonably priced labs they could find.  But I still don't know what that means when some labs can be extremely expensive.

She loves practicing this way because she can spend more time with each patient.  She practices in Savannah, GA, by the way.

[daisylu]

Nov 28, 2022 18:32:36 GMT -5 susana1954 said:

I have a former colleague who decided to go to medical school in her 40s.  This is how she decided to practice.

It is designed primarily for insurance similar to yours.  You will only meet your deductible if you have what would basically be a catastrophic illness.  I have no idea if you get negotiated rates on labs, etc.  Her website says they contract with the most reasonably priced labs they could find.  But I still don't know what that means when some labs can be extremely expensive.

She loves practicing this way because she can spend more time with each patient.  She practices in Savannah, GA, by the way.

The practice that I am looking at did emphasis time with patient - up to an hour if needed. They said similar things - that by cutting out unnecessary insurance claims and issues they are able to really focus on the patient.

Thank you for your input.

[Deleted]

It's something I'd consider if I had multiple medical issues. Right now my only serious one is my heart and that's not the kind where you frequently need same-day appointments. If I had multiple issues I'd be glad to have one person who could look at the big picture and co-ordinate treatments and talk to multiple docs and distill the information for me. Between my PCP, the usual screenings, my cardiologist and Urgent Care for the occasional sinus infection or raging poison ivy, I'm good.

The $75/month should be tax-deductible, too. I always manage to hit the 7.5% threshold even with Medicare because of my premiums (including IRMAA) and teh occasional expensive dental work.

[The Walk of the Penguin Mich]

Nov 29, 2022 8:35:59 GMT -5 @athena53 said:

It's something I'd consider if I had multiple medical issues. Right now my only serious one is my heart and that's not the kind where you frequently need same-day appointments. If I had multiple issues I'd be glad to have one person who could look at the big picture and co-ordinate treatments and talk to multiple docs and distill the information for me. Between my PCP, the usual screenings, my cardiologist and Urgent Care for the occasional sinus infection or raging poison ivy, I'm good.

The $75/month should be tax-deductible, too. I always manage to hit the 7.5% threshold even with Medicare because of my premiums (including IRMAA) and teh occasional expensive dental work.

Are COBRA premiums included in that?

[Deleted]

Nov 30, 2022 10:35:27 GMT -5 The Walk of the Penguin Mich said:

Nov 29, 2022 8:35:59 GMT -5 @athena53 said:

It's something I'd consider if I had multiple medical issues. Right now my only serious one is my heart and that's not the kind where you frequently need same-day appointments. If I had multiple issues I'd be glad to have one person who could look at the big picture and co-ordinate treatments and talk to multiple docs and distill the information for me. Between my PCP, the usual screenings, my cardiologist and Urgent Care for the occasional sinus infection or raging poison ivy, I'm good.

The $75/month should be tax-deductible, too. I always manage to hit the 7.5% threshold even with Medicare because of my premiums (including IRMAA) and the occasional expensive dental work.

Are COBRA premiums included in that?

Included in what?  I'm on Medicare, not COBRA.  (And yes, I deduct my Medicare + Supplement + Prescription + IRMAA premiums.)  Or are you asking if COBRA premiums are included in the $75?  I don't think they are.

[The Walk of the Penguin Mich]

Nov 30, 2022 11:27:59 GMT -5 @athena53 said:

Nov 30, 2022 10:35:27 GMT -5 The Walk of the Penguin Mich said:

Are COBRA premiums included in that?

Included in what?  I'm on Medicare, not COBRA.  (And yes, I deduct my Medicare + Supplement + Prescription + IRMAA premiums.)  Or are you asking if COBRA premiums are included in the $75?  I don't think they are.

Are COBRA premiums included in the 7.5% for medical deductions.

[finnime]

The Walk of the Penguin Mich, yes. Health insurance premiums are included in the allowed deductible expenses up to and over the qualifying 7.5%. Cobra is just another health insurance plan.

[Cheesy FL-Vol]

Nov 30, 2022 12:54:20 GMT -5 finnime said:

The Walk of the Penguin Mich , yes. Health insurance premiums are included in the allowed deductible expenses up to and over the qualifying 7.5%. Cobra is just another health insurance plan.

I could be wrong, but Cobra is offered when you leave a place of employment. You are allowed to remain on the company insurance but you have to pay for the premium in full. The premium is no longer split between employer and employee. It isn't "just another health insurance plan".

I do not recall if there is a time limit that you can use the Cobra option.

[finnime]

Nov 30, 2022 13:47:32 GMT -5 Cheesy FL-Vol said:

Nov 30, 2022 12:54:20 GMT -5 finnime said:

The Walk of the Penguin Mich , yes. Health insurance premiums are included in the allowed deductible expenses up to and over the qualifying 7.5%. Cobra is just another health insurance plan.

I could be wrong, but Cobra is offered when you leave a place of employment. You are allowed to remain on the company insurance but you have to pay for the premium in full. The premium is no longer split between employer and employee. It isn't "just another health insurance plan".

I do not recall if there is a time limit that you can use the Cobra option.

You're right, of course, but to the IRS it is just another plan with premiums paid.

There is a time limit to sign up for Cobra, 90 days, then another for it to stop being available to the former employee.

[The Walk of the Penguin Mich]

Nov 30, 2022 13:47:32 GMT -5 Cheesy FL-Vol said:

Nov 30, 2022 12:54:20 GMT -5 finnime said:

The Walk of the Penguin Mich , yes. Health insurance premiums are included in the allowed deductible expenses up to and over the qualifying 7.5%. Cobra is just another health insurance plan.

I could be wrong, but Cobra is offered when you leave a place of employment. You are allowed to remain on the company insurance but you have to pay for the premium in full. The premium is no longer split between employer and employee. It isn't "just another health insurance plan".

I do not recall if there is a time limit that you can use the Cobra option.

You are correct, but we have been paying COBRA premiums for 18 months and I was curious as to whether or not they could be included in payments for a medical deduction for the IRS.  Between TD's dental work and COBRA, last year we have paid out a chunk for possible deductions.  The US government has some strange rules with regards to COBRA.

It turned out being a moot point for us.

[Ryan]

We have a family friend that is on direct primary care.  It's definitely more expensive than what I pay for primary care medicine, but didn't seem crazy expensive if that's important to you.

The husband is kind of a hypochondriac and I think he likes being able to just text/email the doctor and get a response quickly.  He also said that labs are discounted, although pretty sure they are discounted when you go through insurance too.

His daughter was on the plan and she did not like it.  She said the office was run way too informally for her liking without the security that medical information should have.  She said that they were just too loosey goosey with medical info over email/text.  Sometimes they would get patients mixed up.  

[thyme4change]

I wonder what the difference is between this and concierge?

My parent’s doctor was real early on the concierge service. He wanted thousands of dollars per person, per year plus any services. Then they had someone who would “help” you file paperwork so you could recoup whatever you could from the insurance company. That was at least 15 years ago. So $900 per year to get good service sounds like a bargain.

[Ryan]

Dec 14, 2022 16:06:53 GMT -5 thyme4change said:

I wonder what the difference is between this and concierge?

My parent’s doctor was real early on the concierge service. He wanted thousands of dollars per person, per year plus any services. Then they had someone who would “help” you file paperwork so you could recoup whatever you could from the insurance company. That was at least 15 years ago. So $900 per year to get good service sounds like a bargain.

I asked the same question and they said that direct primary care has no insurance involvement, just the membership fee.  Concierge medicine can be billed through insurance + you pay a membership fee.  Generally speaking, I would think the concierge medicine offers a higher level of service.

I know the goal of both is to allow the patients more access to their docs and for them to be able to spend more time with them.  I wonder if doc offices will start some kind of "consultation plan" that basically gives you more time with your doc if you're willing to pay.  Maybe that is in violation of insurance agreements though.