FAQs
Below are some of the frequently asked questions about Direct Primary Care and Rhode Island Direct Primary Care.
What Is Direct Primary Care (DPC)?
Direct Primary Care (DPC) is a healthcare model where patients pay a flat monthly membership fee directly to their provider. This fee typically covers most primary care services, such as:
- Annual physicals and wellness exams
- Sick visits and urgent care
- Chronic disease management
- Preventive screenings
Unlike traditional insurance-based care, Direct Primary Care practices do not bill insurance companies, enabling more personalized, accessible healthcare.
Can I Use Direct Primary Care With Medicare and/or Medicaid?
Direct Primary Care providers do not bill Medicare for services. Medicare Part B and Medigap-Supplements do not require network providers or referrals. This insurance pairs well with a Direct Primary Care Membership.
Medicare Advantage plans, also known as Medicare Part C, require you to select a primary care provider within their network and obtain referrals for specialists and diagnostic imaging. Direct Primary Care practices do not participate in Medicare. Most Medicare Advantage insurance plans do not align well with Direct Primary Care Membership.
Medicaid: Our practice does not participate with Medicaid insurance plans.
You can reach out to your Rhode Island Direct Primary Care provider to understand how your benefits can work together.
How Does Direct Primary Care Work with My Insurance?
While Direct Primary Care practices do not bill insurance, many patients find that combining a Direct Primary Care membership with their existing insurance plan enhances their overall healthcare experience.
PPO (Preferred Provider Organization):
PPO plans offer flexibility, allowing you to see any clinician without a referral. This makes them compatible with Direct Primary Care, as you can use your insurance for specialist visits or hospitalizations while receiving primary care through DPC.
HMO (Health Maintenance Organization):
HMO plans require you to select a primary care provider within their network and obtain referrals. Direct Primary Care practices do not participate in insurance networks. HMO insurance products do not align well with Direct Primary Care.
It is advisable to consult with your insurance provider to understand how your plan works with Direct Primary Care services.
Do I need Insurance When I Have a Direct Primary Care Provider?
Yes, a Direct Primary Care Membership does not replace healthcare insurance or cover major medical costs. You will need insurance to cover the following:
- Specialist visits
- Hospitalizations
- Emergency care
- Surgical procedures
- Diagnostic imaging
- Lab services
Many patients pair their Direct Primary Care membership with a high-deductible health plan or a medical cost-sharing plan, which often has lower premiums and can be used for catastrophic coverage.
How Does Direct Primary Care Benefit Patients with Chronic Conditions?
Direct Primary Care offers significant advantages for managing chronic conditions:
- Personalized Care: Extended appointment times allow for comprehensive management plans.
- Consistent Monitoring: Regular follow-ups ensure ongoing assessment and adjustment of treatment plans.
- Direct Access: Patients can communicate directly with their provider, facilitating timely interventions.
This model promotes better health outcomes and a higher quality of life for individuals with chronic conditions.
Will I benefit from this if I don't have frequent healthcare needs?
Absolutely — at Rhode Island Direct Primary Care, you will have a dedicated provider who truly knows you and understands your health needs. You’ll no longer have to deal with the frustrations and limitations of a traditional medical office, and you’ll have direct access to your provider whenever you need her. We also offer same-day or next-day appointments to help you avoid unnecessary urgent care or emergency room visits.
Are there medications that Rhode Island Direct Primary Care doesn't prescribe?
At Rhode Island Direct Primary Care, our focus is on whole-person wellness and preventive care. We do not prescribe or manage long-term treatment involving controlled substances. Our goal is to provide comprehensive primary care, and we accept patients whose health needs can be effectively managed within this model. We reserve the right to determine whether our practice is the right fit for each patient’s care needs.
