Let's see if we can answer some of your questions...
Do we accept insurance?
No, we do not accept any insurance at all. We are tired of insurance dictating how much time we can spent with a patient, what we can do and having to choose treatments for patients based on what insurance deems worthy of coverage and not what is best for the patient.
Did you know that it only takes 30 seconds for a physician to prescribe a medicine but 30min not to prescribe a medication?
With physician time being hijacked with overloaded patient schedule, it makes it almost impossible for a physician to spend the needed time with their patient to educate and come up with a treatment plan that does not use a prescription. In addition, if a medication is not prescribed, that patient needs closer and more frequent follow up that would not be covered by insurance.
Do we see Medicare and Medicaid patients?
Dr. Chaminie Wheeler has opted out of Medicaid and is able to see any children that has Medicaid. This means that you can not ask Medicare to reimburse you for our services and you will need to sign a waiver stating this every 2 years. You can continue to use Medicaid like normal everywhere else. On the other hand, Dr. Greg Wheeler is not able to see and Medicare and Medicaid patients currently. This is because, Dr. Greg Wheeler has to work as an ED physician a couple of times a month to provide for his family and make good on the loans we had to secure to get this clinic operational. As soon as we are able to balance our finances without his ED income, Dr. Greg Wheeler will opt out of Medicare and Medicaid. He will then be able to see any patients with Medicare and Medicaid but remember they will not be reimbursing you for his services.
If I join your DPC clinic, can I still use my insurance?
Yes. You can use your insurance to like normally have to cover your medications, other physicians that you see, and really anything that you have been using your insurance for already. You just can not use it for our membership fee or any of our services.
If I join your DPC clinic, do I still need insurance?
Yes, you do need insurance to cover any big ticket items like hospitalizations, surgeries and so on. Because we are able to offer you wholesale prices for medications, and discounted prices for labs and imaging, high-deductable share plans will give you huge cost savings a year on how much you spent on health insurance coverage.
How much does an average insurance plan currently cost an individual in PA?
According to Value Penguin, health insurance premium in 2023 in PA for an individual is $532/month or $6,384/year. This would be an individual would pay $266/mo ($3,192/yr) out of pocket and their employer would pay the other $266/mo ($3,192/yr) just to have coverage. Then, remember, this does not include any copays and deductibles that you must meet if you actually needed care before anything would be covered. Given often minimum deductible is about $2,500, an average individual Pennsylvanian would pay a minimum of $5,692 ($3,192 + $2,500) plus whatever the out of pocket maximum that insurance would if they actually needed healthcare like surgery for a ruptured appendix. The cost of insurance for that individual to "society" is actually (individual out of pocket plus what the employer pays... $8,884). We could extrapolate this to a family of 5 in PA, healthcare could $15,960 out of pocket and $15,960 employer contribution, it would be $31,920 ($15,960 x 2) plus deductibles and copays. According to Business Insider, average mortgages cost less than $18,060 a year in PA. Health Insurance should not cost almost twice as much as your mortgage for a family in PA.
How much would it cost me to have a membership to DPC clinic and catastrophic health insurance coverage?
For our family of 5, we pay $315/mo or $3,780/year for catastrophic coverage. This does not cover any medications, labs or imaging; we would pay out of pocket for those items. Our DPC plan would cost $7,300 for our family of 5 for the year. Therefore, our cost of healthcare would be $11,080 ($3,780 for the Share Plan ans $7,300 for the DPC plan) for the year which is still less than $15,960 out of pocket you now pay and only one-third of $31,920 (out of pocket + employer contribution) actual cost. Yes, the $11,080 does not include medications, labs an imaging but remember $31,920 does not include deductibles and all of your copays. As you can see the transparent pricing for on the Pricing Page, you will be saving $1000s in healthcare NOT using insurance for everything and you will be receiving exceptional care.
Are you able to guide us with some options to get catastrophic health insurance coverage?
Yes. We can give you information on some Share Plans that might be just the right fit for you. You can always work with your own insurance provider and see what their catastrophic plans. Remember as the DPC movement grows and less people use health insurance for everything, insurance profit margins will decline. Since insurance companies are purely a business, they will not want to get left in the dust and will start offering more affordable catastrophic insurance plans. This will foster competition and drive down the cost of healthcare.
Do all DPC clinics charge the same membership fee?
No. There is a wide range of services offered and as well as a wide range of DPC membership fees. We encourage you to explore other DPC clinics as well as private practice clinics that maybe the best fit for you and your family's needs. We want everyone to become part of the movement to change healthcare where all medical decisions can again be made in the bounds of the physician-patient relationship grounded on TRUST and not what is "covered" or dictated.
Where can I find another DPC Clinic near me?
You can use the DPC Frontier to find a DPC physician that maybe closer to you or fit your unique healthcare needs better.
Can I use my HSA (Health Savings Account) or FSA (Flexable Spending) accounts) to pay the membership fee?
Unfortunately, the lobbying power of Insurance companies have much influence with the Federal Government. Thus, money in your HSA accounts are not allowed to be used to pay for our membership fee. We know that this makes no sense; given that it is a HSA/FSA account, you should be able to use it as you see fit for your own healthcare without the government telling you what healthcare means to you. The DPC movement is working on getting this changed, but it is the current law:(
How big is the DPC movement?
According to the Direct Primary Care Coalition, "today, about 1,600 DPC practices in 48 states provide peerless access to great primary care to over 300,000 American patients." An article published in Forbes in Oct 2021, states according to the American Academy of Family Physicians, “DPC benefits patients by providing substantial savings and a greater degree of access to, and time with, physicians. DPC allows family physicians to care for the whole person while reducing the overhead and negative incentives associated with fee-for-service third-party-payer billing.”
Has healthcare become corporate medicine?
Yes. Most physicians do not like the business of medicine. They went to medical school because they wanted to take care of patients. So, when the business side of medicine said "you just see patients, we'll take care of the business," physicians gladly agreed. What they did not realize that by abdicating their right to the "business of medicine," they would be sacrificing the doctor-patient relationship as the sole decision maker of individualized patient care. The rippling effects of this loss of the Covenant of TRUST, has placed a chasm of distance between the patient and the physician. Becker's Hospital Review Publication in Feb 2023 said that "less than 15 percent of board members overseeing the nation's top hospitals have a professional background in healthcare, while more than half have a background in finance or business services..... Among them, more than 80 percent led private equity funds, wealth management firms, or multinational banks. The remainder were in real estate (14.7 percent) or insurance (5.2 percent)." No wonder medicine has become a corporate industry!
As a patient, what can I do to help reestablish the Physician-Patient Covenant of TRUST?
One of the first steps you can do is to do what you can not to be tethered to the insurance card. We need to be a part of the change so that health insurance will model more closely to car insurance. It will cover big ticket items like accidents but not an oil change. Once you come to this understanding, talk to everyone in your sphere of influence to break away from being tethered to their insurance card. By being an advocate for your self and your family, you are engaged in changing medicine.
As a business owner, is there anything I can do to help reestablish the Physician-Patient Covenant of TRUST?
Yes. You know that next to payroll, that the largest line item in your business is cost of healthcare coverage. First, learn about the Health Rosetta business movement to make healthcare local and community based with DPC as it's foundation. This model has been successful in numerous businesses already including how DeSoto Memorial Hospital in Florida, saved 54% or $1.2 Million in Health Plan, and how a car dealership provided better health coverage with less cost just to name a few. Another great resource is Why Direct Primary Care? - Josh Umbehr, MD These are just a few things you can do to educate yourself on how we can partner to change medicine and deliver better healthcare where the Physician-Patient Covenant of TRUST is the foundation.