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What is direct primary care?

The Direct Primary Care (DPC) model is a practice with a payment model where patients/members pay in the form of periodic payment for primary care services. Members are charged a flat monthly or annual fee, under terms of a contract, in exchange for access to our broad range of primary care and medical administrative services.

What kind of services are provided at PearlMed? 

Please refer to Appendix A Monthly Membership Program Services. PearMed is a Family Medicine Clinic.  We see ages from 0-64.   Please see below for Medicare beneficiaries.  If there is not something listed that is meaningful to you, please email us at or call 406-702-1111 and we can answer you directly.

What is NOT available at PearlMed?

We are not health insurance and do not submit claims to health insurance companies . Our monthly membership program takes care of members primary care needs. However, our members are encouraged to have health insurance for items like emergencies, hospitalizations, surgeries, specialists, imaging, and for conditions such as chronic autoimmune diseases and cancer. You, however, do not need to have insurance to be a member of PearlMed DPC.

PearlMed takes chronic pain seriously, however, does not prescribe chronic opiate pain medications, but if appropriate, we will make a referral to a pain clinic to manage these medications.  We use non-opiate medications, muscle relaxants, trigger point injections, joint injections; assist to arrange treatment modalities such as acupuncture, massage therapy, behavioral health counseling; and referrals for interventional therapies such as epidural steroids and facet joint injections.  We are always looking for new modalities to treat chronic pain.  

We do not have or keep any controlled medications at the clinic. This is because these medications are heavily regulated, need substantial monitoring, have a high rate of diversion and for most patients, long term use is detrimental to their overall health and well-being.

We are not a fee-for-service urgent care clinic. We are not an emergency department and do not have the ability to treat patients in a medical emergency.  Patients experiencing an emergency should call 911 or go to the closest emergency room.  We do not offer ‘same-day’ or ‘one time’ visits for non-members. We work hard to meet our member’s needs as they arise and believe in long-term primary care relationships. It’s what we do best.

We do not do maternity care, DOT physicals or determinations for medical disability. We are not the admitting doctor when our patients need to be hospitalized, we use the hospitalist at both major hospitals in Billings.

Currently memberships are not available to beneficiaries of any government health programs.  We hope to change this soon. It requires Dr Wagenaar to Opt-out of Medicare.

​Do you take care of patients in the hospital?

We will often visit our patients when they are in the hospital.  Please call us if you desire this! We will discuss your care and provide any needed charts or records with the hospitalist doctor to facilitate the best possible care. Upon discharge, we will readily follow up with you and your family to try and keep you on the road to recovery and reduce confusion after discharge.


What if I need care on the weekend or after hours?

If you have an urgent after-hours concern that you believe cannot wait for routine business hours, Dr Wagenaar will be available by phone to assist you. While we will come in on the off hours for urgent needs, we find that that need is very rare. We are not available for routine needs or matters that can wait until normal business hours. We are dedicated to your care and to a healthy, cultivated physician-patient relationship.


So, no matter when I need you- you’re available?

No…not exactly. Dr Wagenaar is a Family Physician and can address most problems, most of the time.  There are some circumstances that may require you to see a specialist or visit the ER if your condition requires services that are beyond the capability of our clinic.  We are available by phone to discuss your medical condition and make recommendations, however, our clinic is not an emergency room and accordingly are not equipped to manage patients during a medical emergency.  

We pride ourselves on our affordable medical care and we are cultivating something sustainable, accessible, simple and transformative which requires a partnership with our patients.  We encourage our patients to utilize our services, in person, by phone or electronically, when they need us. We also ask that if matters can wait until waking hours that they do, this will be a win-win for everyone.


What if I’m having a medical emergency?

As is customary with any medical emergency, CALL 911. If you are not having an emergency but feel you need prompt medical care, please call PearlMed .

How does this work with my existing insurance?

You have choices.

We recommend all patients have and maintain insurance coverage for medical catastrophes such as emergencies, cancer, trauma, and unexpected surgery. These events are extremely expensive and there’s no way around it. Patients who need regular sub-specialty care (say if you have multiple sclerosis or rheumatoid arthritis) need reasonable insurance coverage for the specialists they see along with any specialty drugs they may need.

We understand, however, that many hard-working people simply cannot afford insurance. We encourage you to consider consulting with an insurance agent (we can recommend some, if needed) who understand direct primary care. Our patients have found ‘high deductible’ plans that are ACA compliant. Other patients choose to work with cost-sharing programs to arrange some type of financial coverage in the event of a medical catastrophe.

The bottom line, however, is in most situations, insurance or no insurance, direct primary care clinics can save people time, money and headaches with our low-cost, transparent care model.

​What if I don’t have insurance?

PearlMed will take care of you just like everyone else.

What if I have Medicare?

We want you as a patient and we currently have a waiting list.  Currently our program is not available to government healthcare programs beneficiaries. We anticipate this changing in the Spring of 2023.  So if you are interested in becoming a patient or have questions please contact us.   

Can I submit PearlMed DPC charges to my insurance for reimbursement?


Can I get reimbursed for PearlMed fees from my HSA?

Please check with your HSA, all the programs are a little different.

Where are you located?

2795 Enterprise Ave Suite #5, Billings, Montana.

Do you do immunizations?

No not at this time.  Vaccines are available by contacting Riverstone Health or your favorite pharmacy.  PearlMed DPC will make every effort to assist members in obtaining medically necessary vaccinations.  We encourage proper immunization of our patients of all ages and are very open to discussion of questions or concerns.

We will help you with the Centers for Disease Control’s most up to date recommendations.  We don’t have immunizations at the clinic because we have no way to save you money on them. Pharmacies are already so good at this, and they are pretty much sold at cost.

Sounds too good to be true?

It isn’t. When you’ve had enough of what isn’t working for anyone, we’re happy to help you think about something new. What if…

Your wait time, including check-in, was under 10 minutes?

Your phone calls were returned the day you made them?

You had clear pricing for most of your medications at the time they were prescribed?

You knew exactly how much all of your non-emergency medical care was going to cost you next year?

You could see your doctor and not worry about surprise bills 4-6 months down the road?

You could email, facetime with your doctor and send photos related to questions to your doctor?


The delivery of medical care has become complicated and costly. Nobody likes going to the doctor anymore, not even your doctor. We can change this….give PearlMed DPC a try.

Copyright ©2022 PearlMed USA, Inc. All rights reserved.

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