Direct Specialty Care – What Is It and Why Do I Need It?

Most people wonder if direct specialty care is a new concept. The answer is: No, not at all. You may consider it concierge medicine but without the price tag.

Let’s answer a few questions:

“What is and how does it work?”

“Does it work with health insurance?”

“Do I need a membership plan?”

What is Direct Specialty Care?

Direct Specialty Care is a model of healthcare delivery that promotes the patient-physician relationship and removes third-party payors to protect the best interests of patients. 

Direct Specialty Care is a healthcare model different from your typical fee-for-service and insurance billing type of medical practice.Instead, direct specialty care operates like a subscription service.  Direct Specialty Care has an affordable membership fee. You join as a member and, as such, you are entitled to medical services, discounted pricing, and many other services ( e.g. nutrition, mindfulness, and physician therapy classes). It is a direct financial arrangement between the patient and the doctor. If you are familiar with the concept of Direct Primary Care, it is very similar in structure.

For patients that prefer to pay a fee -for- service, a membership fee is still required to join the practice. Only for these patients, we can be provided a superbill for FFS and they may seek health plan reimbursement if they wish.

The result is enhanced patient experience, better health outcomes and more affordable medical care.

 

How does it work?

Think about your Amazon or Netflix subscription plan. Every month, you pay a flat fee, and you gain access to priority or free shipping or access to their TV shows and movies.

In our case, the membership plans may guarantee you a certain number of visits and clinical services, easy access to appointments, better communication with the doctor (email text, phone) and give you access to specialized medical and laboratory services.

Direct care specialists do not charge copayments, and they don’t send you a surprise bill. 

Can I combine Direct Specialty Care with Health Insurance?

Direct specialty care practices are not contracting with insurances. Why? Contracting with insurance companies will increase the practice overhead costs (as more money will be spent coding/ billing services, more office staff).

When the practice overhead is lower, the cost of patient care is significantly lower. 

As we are not contracted with insurance companies, we spend less time, energy, and resources filing insurance claims and following up on reimbursements. Instead, we have more time to concentrate on you, the patient. 

Direct specialty care practice can contract directly with laboratory or imaging centers and offer you transparent and discounted prices upfront. We will save you money.

However, if you have insurance, you are welcome to use it to cover the cost of your tests, imaging, and medication. 

That becomes your choice. You, as a patient, have the power to choose between paying a cash price vs. a “covered” service.

Whether you have insurance or not, anyone can have a membership.

 

Do I need a membership plan to be seen?

The first visit is always needed to see if we can help you and we are a food fit for your medical care. Signing up for the membership is required to continue care in our practice.

Here are the benefits of becoming a member:

  • longer appointment times
  • no rushed appointments
  • better patient-physician relationship
  • continuity of care between the physician and other specialists and your primary care
  • direct communication with the physician
  • same day/ next day appointments
  • transparent pricing disclosed up-front
  • no copayments
  • no surprise bills
  • discounted pricing on labs
  • discounted pricing on imaging studies
  • lower medical costs

Direct specialty care rebuilds the relationship between patients and physicians and makes medicine uncomplicated, improving patient access to excellent care. 

We treat people, not diseases. 

Our patients are in charge of their health, and together, we make informed decisions about their healthcare.

If you are interested in direct specialty care services, contact us or schedule your first appointment.

Sincerely,

Diana Girnita  MD PhD
CEO & Founder of Rheumatologist OnCall

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