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What is direct primary care (DPC)?

Practically speaking, DPC is a membership model for healthcare. DPC is a new way to get high quality, comprehensive healthcare from a doctor who cares, all for a low, flat monthly fee. No additional insurance copays. A few minor procedures have additional fees (see appendix A) We also offer labs and in house prescriptions at significantly discounted prices, otherwise the monthly fee just about covers it all. To get a far more detailed answer, check out Services in the menu.

What kind of services are provided at PearlMed DPC?

PearlMed DPC offers Family Medicine services provided by a board certified Family Physician for a broad range of medical conditions and minor procedures. Please refer to our Appendix A Monthly Membership Program Services for further details. 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.

How much does direct primary care cost?

Please refer to the Pricing tab in the menu for a full list of details.

Can direct primary care save you money?

You bet! Let's go over some common scenarios where a PearlMed DPC membership can save you money. #1 You're taking multiple medications. If you're taking multiple medications and paying with insurance for all of them, your co-pays are probably stacking up. Direct primary care practices frequently dispense common medications directly from their offices, so you won't need to do an extra trip to the pharmacy. Plus, your DPC doctor will purchase these medications at wholesale prices from a free-market vendor like Andameds or Henry Schein, and they pass those savings through to you. Some practices add a small markup (say, 10%), others sell these medications at cost. The value of this service depends on which medications you're taking. Often your insurance provider will only cover a drug from a particular drug manufacturer, or they'll require you to use a brand-name version even though a cheaper generic is on the market. If that's the case you can easily be paying hundreds of dollars a month on medications—money you could save as a DPC member. #2 You get injured. If you get in an accident, break a bone, need stitches, or require emergency medical care of any sort, you'll probably go to an urgent care or the emergency room. Going to either of these is a surefire way to drain your pocketbook. In the best base scenario, the urgent care center is in your insurance network and you pay a high co-pay—up to $100 in some cases. But that's only if you're lucky. Insurance coverage of emergency care is spotty at best, and urgent care centers are known to mislead patients regarding the true costs of care. Even if you verify multiple times that your insurance will cover your care, you can still get hit with big bills. Often urgent cares don't know if your insurance is actually valid, or they'll intentionally mislead you. Emergency rooms are even worse: you'll often have to pay a co-pay of $1000 or more just to get seen, PLUS the cost of any additional scans or treatments. There are dozens of horror stories online about unwitting patients who were financially ruined by insane ER bills they thought were covered by insurance. One bad day can cost you thousands of dollars—enough to cover years of a DPC membership. As a DPC patient, you know exactly who to call when you need help. #3 You're overpaying for insurance. If you're on an insurance plan named after a precious metal, you shouldn't be. Health insurance companies have been over-reaching for years—to read more about this, check out our essay on the healthcare crisis. Even the cheapest health plan your employer offers covers WAY more than it should, so don't get conned out of more money by picking a low-deductible "Platinum" plan. As a DPC patient, the majority of your healthcare will be taken care of by your DPC doctor. All standard care, wound treatment, blood work, preventative screens, and physicals will either be included in your membership or provided at a fair price by your doctor. If your DPC doctor isn't equipped to deal with a medical issue, it's probably serious. And if it's serious, then you'll very likely hit your out-of-pocket maximum (OOP). (This OOP is what it sounds like: the maximum amount you can possibly spend on healthcare before your insurance plan starts footing 100$ of the bill.) Here's the thing: the OOP for the cheapest and most expensive plans don't vary that much. Aetna's cheapest plan costs roughly $600 per year and has an OOP of $6650. Their most expensive plan costs $4200/year with an OOP of $4000. That means you'd be paying a guaranteed $3600 extra dollars ($4200 - $600) to avoid the small chance of paying an extra $2650 (6650 - 4000) on your healthcare. That doesn't make sense! Unless you're expecting to suffer a major health crisis every 9 months, you'll be better off on a cheaper plan. Otherwise, just join a DPC practice and take the cheapest insurance you can find! Do none of those scenarios apply to you? Here's one more: #4 You care about your health. Here's the thing: direct primary care is the best game in town when it comes to healthcare. Think of it this way: before DPC, only movie stars and the super-rich were able to afford a personal doctor who works tirelessly to keep them healthy. To keep a personal doctor on staff costs around thousands of dollars per month. The rest of us had to a) wait until we were sick before talking to a doctor, then b) schedule a visit weeks in advance just to c) spend 10 minutes with a doctor we'd never met. With PearlMed DPC, everyone can have a personal doctor on speed dial for a shockingly low amount. Having a medical expert at hand to answer questions, keep track of your preventative screenings, advise on your diet and lifestyle, and actually care about your happiness was simply not possible before. Now it is. By splitting hairs over tens of dollars per month, you're missing out on the best deal in healthcare.

Why is direct primary care a monthly membership?

If it seems like everything is a subscription these days, that’s probably because it is! And with good reason: subscriptions are the best way for a business (of any kind) to offer high-quality service and support over a long period of time. If you long for the days when software cost hundreds of dollars and came in a box, PearlMed DPC might not be for you. The alternative would be itemized, "usage-based" pricing—the exact pricing scheme used by the traditional healthcare system. And that didn't work out so well for anyone. There are a hundred little perks of being a PearlMed DPC patient—check out a comprehensive list of benefits here. Frankly, the benefits of being a PearlMed DPC patient are too varied and rich to be broken down into a "menu of services". Paying your DPC doctor for everything they do would be like paying Netflix for every episode of TV you watch. Sounds awful.

Is direct primary care the same as concierge medicine?

You may have heard of a similar model called "concierge medicine". While there are similarities with DPC, the two are different in some fundamental ways. For starters, concierge practices often bill your insurance in addition to a monthly fee (though some don't—which makes them DPC practices!). This means they're still a part of the insurance industry's ridiculously complex reimbursement system, so they have to hire administrators to handle all the paperwork. This gets reflected in your monthly fee; the average concierge practice bills $200-300 per month. By comparison, DPC memberships cost approximately as much as your cell phone bill. Concierge was a step in the right direction, but it didn't go far enough. To bring sanity back to primary care, you need to cut insurance out of the picture entirely.

How does this work with my existing insureance?

Direct Primary Care compliments insurance well! We recommend and encourage all patients to have and maintain insurance coverage for medical catastrophes, emergencies, unexpected diagnosis of cancers, trauma, and surgeries. These events are extremely expensive and there’s no way around it. Insurance can be a financial life saver. Patients who need regular sub-specialty care (say if you have multiple sclerosis or rheumatoid arthritis and see a neurologist or rheumatologist) also need reasonable insurance coverage for the specialists they see along with any specialty drugs they may need. PearlMed’s services are covered by your monthly membership fee and applicable charges noted in appendix A making our cost transparent. We take out the “middleman.” by not billing insurance for our services. . You have choices! Our goals are to save you money by managing your primary medical conditions and minimizing the need for specialists and avoid unnecessary trips to the urgent care for things that can be handled by our Family Physician. Direct Primary Care adds unsurpassed value by adding convenient, reliable service that decreases hassles in managing your primary care needs.

What if I do NOT have health insurance?

Direct Primary care is for you! Direct Primary Care makes access to a Board Certified Family Physician affordable. We believe that primary care is very important for everybody in maintaining good health. We understand that many hard-working people simply cannot afford health 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 to be cost effective and provide reasonable coverage. 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 is, in most situations, insurance or no insurance, direct primary care clinics can save people time, money and headaches by using our low-cost, transparent care model.

What if I have Medicaid insurance?

Our doctors are available to you! We do not bill Medicaid and you can not submit the charges for our services to Medicaid for reimbursement. We believe that having access to a Board Certified Family Physician is important to your health.

What if I have Medicare insurance?

We are currently taking a waiting list and will call you when our office is eligible to see patients with Medicare Insurance. Membership in the Poogam is not available to beneficiaries of Medicare. If Patient becomes a Medicare beneficiary, he or she agrees to immediatley notify Prctice.

What if my medical condition needs medical services not available at PearlMed DPC?

Dr. Wagenaar is a Family Physician and can address most problems, most of the time, but not all concerns. There are some circumstances that may require you to see a specialist if your condition requires services that are beyond the capability of our clinic. We will happily refer you to a specialist and help coordinate your care. We pride ourselves on our affordable medical care and we are cultivating something sustainable, accessible, simple and transformative. We are a partnership with you, our patients. We encourage our patients to utilize our services, in person, by phone or electronically, when they need us.

What if I'm having a medical emeregency?

Our clinic is not an emergency room. As is customary with any medical emergency, CALL 911. Please do not delay your care. If you are not having an emergency but feel you need prompt medical care, please call PearlMed DPC. We are available by phone to discuss your medical condition and make recommendations.

Is PearlMed DPC a Walk-in Clinic?

We are not a walk-in clinic but we do offer same day/next day appointments to our members.

Should I join a direct primary care practice if I'm healthy?

Absolutely! To be sure, your PearlMed DPC doctor will always be there for you if you get sick or hurt. But they also work proactively to keep you healthy, happy, free of preventable diseases, and living a good lifestyle. It's hard to break out of the mindset of the insurance-based healthcare system. In "the system", everything is centered around treating illness. It's very hard for a doctor to get paid by an insurance company for detecting early warning signs of diabetes or encouraging a lifestyle change to decrease risk of heart disease. Doctors just aren't rewarded for encouraging all-around good health. By being in constant contact with your PearlMed DPC doctor when you're healthy, you'll be able to stay that way. By the time you're being treated for a chronic disease, it's usually too late. But if you spend your healthy years under the watchful eye of a doctor that cares, you'll be able to stay out of the hospital for years to come.

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

Dr. Wagenaar & Dr. Williams are available by phone to assist you. If you have an urgent after-hours concern that you believe cannot wait for routine business hours Dr. Wagenaar will help you decide what is the best course of action and will come in to see you on off hours to evaluate you if needed. We make a point to make ourselves available for routine matters during normal business hours. We are dedicated to your care to maintain a healthy, cultivated physician-patient relationship.

Does your office give immunizations?

No not at this time. We do not do immunizations at our 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. PearlMed DPC will make every effort to assist members in obtaining medically necessary vaccinations. We help you to be informed of the most up to date recommendations. Vaccines are also available by contacting Riverstone Health Immunization clinic We encourage proper immunization of our patients of all ages and are very open to discuss your questions or concerns.

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?

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