FAQs

Direct Primary Care (DPC), commonly referred to as DPC, is a model of healthcare delivery in which patients pat a monthly or annual fee to have direct access to primary care services, typically from a physician or small group of physicians. It is a fast-growing way for family doctors to provide high-quality, unrushed healthcare to patients at an affordable, predictable price.

DPC doctors are still regular family doctors who can take care of almost 90% of your typical medical needs. You can be a member whether you have insurance or not. However, there is typically no insurance involvement and no billing for services. All that paperwork and documentation drives up costs and takes time away from patients, leading to rushed and inattentive doctors. Instead, patient's pay an affordable monthly membership, and in return they get more attention and unlimited access to their doctor (in clinic or directly through telehealth, text, and email) saving them lots of time and money overall. Doctors get to focus on quality of care (not quantity), leading to healthier, happier patients.

DPC practices often have lower overhead costs than traditional primary care practices, which allows them to offer more personalized care at a lower cost to patients. Labs and imaging are significantly cheaper than what you would pay through insurance, resulting in more cost savings. In a system where you usually have to pay more to get more (or just not be able to afford it), DPC is a way to save money while getting more personalized and thorough health care.

Having insurance is great for situations like emergencies, hospitalizations, and specialist visits. However, the way the insurance-based system is now, it's not good for quality primary care. By not taking insurance, we cut out a lot of the extra time and costs associated with “regular” doctor's visits. The result is that you actually get to spend time with your doctor--no lengthy check-ins, no long waits and rushed visits, and no unexpected or unexplained bills. You get the full benefit of a true doctor-patient relationship so you can get the complete health care you deserve without having to worry about unexpected bills or unexplained costs.

Most doctors' offices need to take patients with insurance in order to operate. Patients pay for insurance, then insurances pay doctors when a patient uses that insurance (for example, for a regular sick visit). However, doctors must send detailed office notes with specific requirements set by insurance companies to document the visit so they can get paid for it. That's why doctors are always typing away on the computer rather than listening to you during the visit.

Unfortunately, insurance companies don't make things easy. And if you have ever dealt with insurance companies as a patient, you know they can really make things confusing on the patient's end, too. This whole process has created a very complicated (and very expensive) healthcare system in America. As a result, medicine has become a business, where doctors have become employees and patients have become products. Instead of focusing on the quality of patient care, doctors have to focus on the quantity of patients to cover all the overhead that comes with dealing with insurance, which usually means seeing 20 or more patients per day.

If we took insurance, we would be forced to operate like the typical factory-style clinic where you would get on average 5-7 minutes to spend with your doctor. And that's not including all the time you took off work, checking in, waiting for the doctor, checking out, and Googling after your visit because you didn't get all of your questions answered.

At Pathway DPC, you get direct, personal access to your doctor. This means unlimited, same day or next day appointments, no waiting in the office, and all the time you need to get all your questions answered to the fullest. You get as much or as little follow-up as you need on your own schedule via text, email, telehealth, or in-person without extra co-pays for each visit. We get rid of the middleman (i.e., insurance) so your doctor can focus on what's most important - YOU!

Although we aim to address the vast majority of members' primary care needs, membership at Pathway Direct Primary Care does NOT replace health insurance. It can, however, allow you to choose cheaper options when choosing your health insurance. For example, many members have a “high deductible” health plan that costs less per month, and they use part of the savings to pay for the membership. Also, with unlimited visits, no co-pays, and cheaper labs and imaging even when compared to “good” insurance plans, members save a lot of money and time while getting better quality out of their doctor visits, since they can usually get more done at a lesser cost.

We recommend that our members maintain active health insurance to be used for services not offered by our practice, such as appointments with specialists, urgent care/emergency room visits, and hospitalizations. Membership with Pathway DPC can help you navigate these situations better and may help you minimize or avoid the need for them, but it's important to be prepared for life's unexpected moments.

Recently, some alternatives to traditional health insurance companies have been gaining in popularity. You may actually be able to save money by joining a healthcare cost-sharing community.

To learn more about how these communities go hand-in-hand with DPC, check out Sedera Health (note: I have no affiliation with Sedera Health).

Our philosophy is that health care should be accessible and affordable for EVERYONE.

Direct primary care might actually be the best option for people without insurance. Lots of people either don't have insurance through their jobs, or they have bad insurance, or they are forced to get a plan through the marketplace, which is very confusing and very expensive (I have looked through it for myself and for family members, so I know)! So they take a gamble and go without insurance, and if they ever get sick, they go to an urgent care/ER or schedule a self-pay office with a doctor that doesn't even know them. Over time, this leads to more health problems and more medical bills. It's an unfortunate reality that too many people have to deal with.

The price of a monthly DPC membership is much cheaper than the cash-price of any urgent care, ER, or regular office visit at a “traditional” doctor's office. In fact, you can actually spend more time with the doctor and see him more often without having to pay more for every visit. Plus, labs and imaging are up to 90% cheaper. This means you don't have to choose between an overly-expensive insurance plan or no insurance at all, and you don't have to wait until you get really sick to go see a doctor.

There are many ways even “healthy” individuals can benefit from a membership with Pathway Direct Primary Care.

Just like you might take your car for a tune-up once or twice a year to make sure it continues to work OK in the long-run, even if it doesn't have any major problems, we should give our bodies a “tune up” at least once or twice a year. Good maintenance will help keep things working right and can prevent future problems. But just like we would want a good mechanic to do a thorough job to keep our vehicles in good condition, everyone should have a good doctor spend the time to do a thorough examination. This should include a detailed discussion (not just a questionnaire for insurance purposes) about diet, exercise, family history, work/life balance, and stress/anxiety/mental health to promote holistic well-being and a healthy lifestyle.

In the current “healthcare” system, everything is centered around treating illness, which really makes it more of a “sickcare” system. DPC doctors can not only help manage chronic conditions but also provide patients with enough time and attention to focus on “whole person” health and disease prevention to help healthy individuals stay healthy.

Others see value in the convenience/accessibility of direct primary care. You may not need a doctor often, but when you do, you probably don't want to wait days to weeks to be seen. Or maybe you're on vacation, but something happens and you need to speak with your doctor quickly. Unfortunately, long wait times and limited access to doctors when patients need it force many people to go to an urgent care or ER, where the price of one visit may cost more than an entire year's membership to Pathway DPC! Direct primary care members don't have to deal with long waits and playing phone tag with office staff, which can end up saving a lot of time and money. They have the peace of mind knowing they can contact their personal doctor, who knows them well, without difficulty.

Also, some people have specific health goals in mind, whether they are training for athletic competition or they are trying to avoid heart disease that is common in their family. We all have different definitions of what it means to be “healthy”, and each patient at Pathway Direct Primary Care can be assured that their doctor will personalize and individualize their care according to what the patient finds important.

Whatever your health status, it's a good idea to consider your overall healthcare situation and decide if Pathway DPC is right for you.

Although both DPC and concierge practices offer similar services (increased access to their doctor, extended time visits, and fewer patients per doctor), there are some important differences between these two models.

Typically, concierge practices bill insurance for each visit. On top of insurance charges, members pay an additional fee (“retainer”) simply for access to their doctor. This fee can be quite costly, ranging from thousands to tens of thousands of dollars per year, since concierge practices still need to hire administrators to handle all the insurance paperwork. The average concierge practice bills $200-300 per month.

DPC practices do not bill insurance. Instead, patients pay an affordable monthly membership fee straight to their doctor's office, usually about as much as your cell phone bill and less than the cost of some streaming services. In exchange, patients receive direct access to their physician and comprehensive Primary Care Services. By stepping away from insurance based care, DPC practices are able to reduce costs, eliminate unnecessary barriers to care, and shift the focus back to what's important: the doctor-patient relationship.

DPC doctors are regular doctors, so they can still write prescriptions, make referrals, and order lab/imaging. More importantly, DPC doctors will have more time to help with these things, such as:

1. Refilling medications in a timely manner.
2. Consulting directly with specialists about your medical care to save you time and money, or helping you with referrals and communicating effectively with specialists in a complicated medical system.
3. Explaining your labs, scans, and other tests in detail and on time so you can better understand your overall health without getting expensive and unnecessary tests and follow-up visits.

Pathway DPC has negotiated directly with local labs and imaging centers to secure discounted, transparent, cash-pay pricing for members. Patients with insurance can also elect to use their coverage for these services, but this will often actually end up costing more. Many people choose to use their HSA funds to pay for the cheaper cash-price for labs and imaging.