Why Direct Primary Care?

Dr. Shabazz first made an annoucement on Facebook that we'd be transitioning to a Direct Primary Care (DPC) hybrid model in November 2021. Many patients want to know why we are making this change. Direct Primary Care is an increasingly popular model of care that many independent physicians and their patients are choosing. 

  • Micro-management by insurance companies has gotten out of control.

  • Despite high premiums for health insurance, deductibles and other out of pocket costs for patients have gotten higher and higher.

  • Having lots of patients in the insured model detracts from the level of attention each patient can get.

  • We can do what you've come to expect: Keep it real with you!

Frequently Asked Questions

What is Direct Primary Care?

Direct Primary Care (DPC) is a practice style that is quickly spreading across the country. If you have a commerical insurance plan (ie insurance through your job or the healthcare exchange), we won’t accept your insurance and instead will contract directly with our patients to provide medical services for an affordable upfront fee that fits most income levels. The core structure has several basic principles that return the privacy, quality and time to the doctor-patient relationship.

What are the advantages to DPC for me?

There are no copays. You can schedule as many appointments as you need, call, or send a secure text or portal message whenever you need. Everything that is routinely done in the office is included (physicals, forms, EKG’s, lesion freezing or removal, nebulizer treatments, on-site testing, etc.). For any tests that must be sent out, you have the option of using your health insurance to cover those costs. If you do not have health insurance, we have discount arrangements with a lab that allows you to get charged at our cost, which is usually the lowest price available.

Because we are taking the middleman out, we can maintain the practice with fewer patients. Visits are scheduled for between 20-60 minutes long depending on what you need. I already try to be thorough and discuss lots of issues at one visit, but that often causes me run late. Now, if we need to schedule another appointment to take care of other issues, there’s no extra cost to have another visit the next week or as many visits as it takes to get you squared away.

You’ve always had after-hours access via phone. Now we will also be able to communicate via secure text message. There may be times when you need to go to the ER or urgent care center, but most times, we could figure out how to get you taken care of without that extra expense.

We will reserve space on the schedule for same day/next day DPC visits either in person or via telehealth.

We are actively negotiating discounted prices for medications, labs, & imaging. These costs are often pennies on the dollar and can be applied to an HSA, FSA or out-of network deductible. You may be able to off-set the cost of the upfront service fee through submission of a fee slip to your plan when you have an office or telehealth visit.

There are no denials of care we provide or insurance company restrictions on what is ordered. The art of healing cannot be timed, quantified, or restricted.

What is included?

  • All Office visits 

  • All Telemedicine appointments

  • Extended appointment times  

  • Special after hours access line

  • Free forms completed

  • Medical marijuana certifications for appropriate patients included

  • 25% off Pure Encapsulations orders 

  • Discounted labs* 

  • Free in-office testing**

  • Free/discounted procedures*** 

  • Care coordination – Our office can help coordinate with specialists 

  • No- "no show" fees 

 

*Labs done by a third party will be at a discounted rate. 

** Our office in office testing includes; strep test, pregnancy test, flu and urinalysis. 

****Examples of procedures that are done in office include; joint injection, nebulizer treatment, laceration repairs, IUD insertion (must buy device before insertion) and ear lobe repairs.

How much will this cost?

The cost of the annual medical service will be based on the payment plan you choose:

  • $1200/yr for adults or $600/yr for children under & young adults aged 0-21 when paid in one lump sum.

  • $119/month ($1200/yr + $228 processing fee) if paying in 12 monthly installments. First 2 months due at sign up.

  • $325/quarter ($1200/yr + $100 processing fee) if paying in 4 quarterly installments.

  • Families with 5 or more people will receive a 12% discount on the total cost of their family's membership. 

As we withdraw from participation in various insurance plans, our current patients will have a window of time to enroll at a discounted rate. When we announce that we are going out of network with a particular plan, we will let our current patients know how long they have to sign up for the discounted price of $999/yr when paid in full or $99/month ($1188/yr) when enrolling in an automated monthly payment plan. Your year of service will start on the date that we are officially out of network with your insurance.

I live too far away, do you have a telehealth-only option?

Yes! If you live >100 miles away and you never plan to come in for an office visit, you can enroll in our Virtual DPC plan for $900/yr for adults and $450/yr for patients 16-21 when paid in one lump sum. At this time, children younger than 16 may not be enrolled in the Virtual DPC option. The processing fee as shown above will be added if you choose to pay in monthly or quarterly installments. If you decide to schedule an in-office appointment, you will be charged $200 per visit.

What if I can’t afford this?

We will continue serving our Medicaid and Medicare patients to make sure that those most in need will be able to keep Dr. Shabazz & Fountain Medical Associates as their PCP using their government benefits. However, we will only have a limited number of Medicare Advantage Plans with which we participate. When the next open enrollment period rolls around, we will further streamline to the Medicare Advantage plans that are easiest for us to work with. You should expect that by 2023, we will only be accepting Health Partners Medicare & Medicaid, Cigna Medicare, and Medicare Part B (with or without a supplemental plan).

I have Medicare, can I enroll in DPC?

No. Unfortunately, government regulations prohibit physicians and other medical providers who participate in Medicare from enrolling Medicare beneficiaries in Direct Primary Care services. Many Medicare beneficiaries may be eligible to enroll in Chronic Care Management services using their Medicare benefits.

Do I still need insurance?

Yes…and no. While insurance is not required to stay with us as a DPC patient, we strongly recommend that you maintain some type of coverage. While primary care services are affordable, unexpected health expenses like hospitalization are one of the leading causes of bankruptcy. We are negotiating discounts for many common outpatient services, but it is wise to have something in place for big medical expenses.