Frequently Asked Questions (FAQ)

General Questions

 

What is Direct Primary Care?

-Under the Direct Primary Care (DPC) model, the patient (you) receives comprehensive primary health care directly from their DPC physician (Dr. Manire). The patient pays for this care through a monthly fee, paid directly to Our Family Direct Primary Care.  That fee covers many primary care services listed on our services page.

 

-Because DPC practices do not participate in any insurance or plans, the providers are able to avoid the ever-increasing and costly documentation demands and administrative intrusions that come with accepting insurance.  DPC practices also avoid the onerous patient data collection responsibilities which many plans impose. These require lots of staff, time, and resources – and often amount to substantial intrusions on patient privacy.

 

-Because DPC physicians avoid these obligations to insurance companies, they are free to spend that time listening to and treating patients. And because DPC physicians eliminate the significant overhead costs of participating in insurance, they can pass the savings on to you, the patient – and give compassionate, attentive and timely care at an affordable cost.

 

Why is a DPC practice a Better Option?

-There are lots of reasons. First, it is absolutely patient-focused. From a cost standpoint, it helps patients and their employers maximize their healthcare benefits while simultaneously minimizing the cost. EVERYONE can benefit from being part of a Direct Primary Care practice:

Medicare beneficiaries:  Savings on medicines can help many Seniors who have substantial out of pocket expenses for their prescriptions, and the exceptional access to your doctor enhances wellness plans as well as diagnosis and care of chronic medical conditions. Probably the biggest value is the knowledge that your doctor – not a large entity like an “Accountable Care Organization” trying to cut costs for Medicare – is helping you co-ordinate your care to suit your individual healthcare needs.

Small business owners and their employees:  DPC combined with a “bronze” plan and a Health Savings Account is a great alternative to expensive insurance plans. They can cut costs by 20 – 30 percent or more and money previously spent on premiums can be reinvested in the company or given back to valued employees as bonuses or pay raises.

Individuals without employer coverage who can’t find high value plans that allow choice in providers and hospitals on the government health insurance exchange can benefit by  having more control over where and how care is accessed.  They can also stabilize unpredictable spending toward deductibles by having a set monthly fee for comprehensive primary care.

Individuals who don’t require frequent medical attention benefit also.  Building a partnership with a personal physician and investing in preventive care and wellness will pay off.

Self-insured businesses can build custom health benefits for their employees. DPC is a perfect fit for these companies because, in many cases,  it can help lead to a 20 – 30 percent drop in overall healthcare spending and dramatically improve employees’ satisfaction with their benefits.

 

Is the monthly fee for Direct Primary Care (DPC) tax deductible?

-Not currently.  But things are changing.  Some states have clarified that DPC is a medical expense and therefore should be tax deductible.  Please consult your accountant to get the most up to date information.

 

What about people who can’t afford DPC?

-DPC is considered very affordable for most people. However, with the DPC model, doctors are free to offer charity care or reduced charges based on need. Because of Medicare and health plan contracts, this is illegal in insurance based practices.  Charity is actually discouraged by our current insurance-based health care system!

 

Do you see nursing home patients?

Not at this time. This service may be added in the future.

 

What if I’m hospitalized?

Dr. Manire will work closely with hospital physicians and specialists.  If you request it, he will visit you while you are in the hospital and be your “quarterback,” thoroughly coordinating your care in an efficient way.

 

Are my medical records ever shared with insurance carriers or government agencies?

No. Patient privacy is a natural benefit of this medical model. We will never provide any third party with a copy of your records without your express written consent or if Our Family Direct Primary Care is subject to subpoena or search warrant.

 

What if I need medical attention while I’m away from home?

In the age of telemedicine, many conditions can be diagnosed and treated via a simple conversation by phone or webcam. If appropriate, we will locate the nearest pharmacy and order medication most suited for your circumstance. If you need to go to the hospital or seek other medical attention while away from home, we can advise you on that as well.

 

May I contact Our Family Direct Primary Care after hours? How?

Absolutely, yes! It’s how we do custom healthcare. After normal office hours our members can call Dr. Manire cell phone.

 

When do I pay my fees for wholesale medicines and labs that are not covered?

Charges will be added and applied to your preferred method of payment at the end of month automatically. You always access to your charges through our mobile app.

 

 

Membership Questions

 

What medical questions do you care for?

-We treat acute and chronic health problems.

 

What are your prices?

-Please find a complete list of our prices here.

 

What does the membership fee cover?

-The fee covers excellent primary care through office visits with minimal wait times, annual wellness exams, well-child exams, sports physicals and school physicals, basic office procedures, treatment of acute illness or minor injuries, chronic disease management, and expanded access to your doctor via email, phone, text and Skype.

 

-Our patients will also have access to wholesale labs, imaging, and medications not included in the membership fees.

 

-View a list of our services here.

 

Is there an enrollment fee to join?

-Yes, there is an enrollment fee of $75 paid at the time you join.

 

Does Our Family Direct Primary Care see patients of all ages?

-Dr. Manire is a board certified family physician.  He is trained to provide comprehensive primary care for people of all ages, from newborns to elderly.

 

Do I have to sign a long term contract?

-No. We do not require any long term commitments. Kentucky requires you and Our Family Direct Primary Care to sign a membership agreement protecting both parties. Our membership agreement is initially for one month. There is no need to sign a new agreement for the next month as your initial agreement will continue until either you or Our Family Direct Primary Care cancels the agreement.

 

What if I decide to cancel?

-We expect to have an honest, open, and respectful relationship with you. If you have voiced a complaint that we cannot satisfy together, we will gladly allow you to terminate your membership per membership agreement at any time. If you choose to rejoin, a re-enrollment fee will be applied.

 

Insurance Questions

 

Is this like MDVIP?

-No. MDVIP charges higher fees annually:  $1650 for individuals or $3300 for couples. Our Family Direct Primary Care maxes couples and family fees at $185 per month and there is no long term requirement. MDVIP bills insurance on top of the annual fee. Our Family Direct Primary Care does not bill insurance for anything. MDVIP does not offer savings on wholesale medicines and labs. Our Family Direct Primary Care passes along these savings, which often fully pay the monthly fee for DPC services.

 

Do I still need insurance?

-We recommend that you do have insurance to comply with Federal Law. Our Family Direct Primary Care does not replace insurance, and ideally we encourage our patients to carry a high deductible or major medical plan or a plan with a health savings account, thereby ensuring financial help should hospitalization or coverage for catastrophic medical expenses or referral to a specialist be necessary. You should consult with an insurance provider to help you find a plan that works best with our medical model and that will meet your specific needs.

 

What if I want to continue my current insurance? Can I use it?

-Not for our services, but Our Family Direct Primary Care will be able to order your labs, imaging, and medications at the facilities preferred by your insurance if you would like.

 

If I have Medicare, can I join as a patient?

-Yes. However, your monthly membership fee cannot be submitted to Medicare for reimbursement. You must sign a waiver that declares that neither you nor your doctor will directly bill Medicare for your membership fee.

 

-Medicare and Medicare supplemental insurance will still cover medical costs that you incur outside of Our Family Direct

Primary Care. For example, prescriptions that you fill at an outside pharmacy, or labs run at an outside lab, or hospital charges, physical therapy, x-rays and scans are covered, just to name a few. You do not lose your Medicare coverage for other medical needs just because you are a patient of Our Family Direct Primary Care.

 

If I have Medicaid, can I join as a patient?

No. An executive order by former Governor Bashear prohibits private agreements with Medicaid recipients.

 

Are Our Family Direct Primary Care’s monthly fees, other charges eligible for HSA or FSA reimbursement?

-Yes, our fees and charges are generally reimbursable. This is one smart method of paying for your health care needs with pre-tax dollars.

 

-Direct Primary Care may qualify as reimbursable through your Health Savings Account (HSA) and may also qualify under the Affordable Care Act.  Section 10104 of P.L. 111-148 (Patient Protection and Affordable Care Act) states: “The Secretary of Health and Human Services shall permit a qualified health plan to provide coverage through a qualified direct primary care medical home plan that meets criteria established by the Secretary, so long as the qualified health plan meets all requirements that are otherwise applicable and the services covered by the medical home plan are coordinated with the entity offering the qualified health plan.”  See your insurance provider for questions.

 

If we haven’t fully answered all of your questions, please contact us via phone or email so we can further assist you.