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Direct Primary Care (DPC) | Medicare Concierge

Weight LossFunctional MedicineMen’s Health

The Fine Print

FAQ: Direct Primary Care

What exactly is Direct Primary Care?

Direct Primary Care (DPC) is a healthcare model that focuses on establishing a direct relationship between patients and their healthcare providers. Instead of billing insurance for every visit, DPC operates on a membership-based system where patients pay a monthly fee. This fee covers unlimited access to their provider, ensuring personalized, immediate care. It fosters a more personal patient-provider relationship, eliminates insurance-related paperwork, and offers patients more time with their providers. It’s a win-win!

It’s important to note that a DPC membership, while similar to concierge medicine, is much more affordable, and doesn’t include after-hours care. Typically, services that offer such care charge between $5,000 and $10,000 a year and also bill insurance on top of that.

Interested, but not sure if a DPC membership is right for you? Schedule a free, no-obligation discovery consultation to find out more!

What does the DPC membership include?

For a reasonable monthly membership fee, our DPC members receive a comprehensive suite of primary care services. This includes unlimited visits, same or next-day appointments, and enhanced access via Telehealth, phone calls, or messages.

Need to see us? No problem. Need to see us again? Come on in! Just have a question? Fire off a message and we’ll get back to you.

Many minor procedures and in-clinic medications are included in the membership fee. Some in-clinic medications, tests, and procedures may incur an additional charge, but you’ll always know up-front and before committing to care.

We’d be remiss if we didn’t note that neither the DPC nor the Medicare Concierge plans cover third-party specialists, labs, imaging, or prescriptions. However, we are dedicated to guiding our members through the healthcare system and helping you secure these services at reasonable prices when needed.

Interested, but have more questions? Schedule a call and we’d be happy to discuss your situation and how our services and plans may be able to help you.

If I have a DPC membership, do I have access to your other programs?

While the DPC membership is separate from our specialized programs, members do receive exclusive discounts for our other services like Weight Loss, Functional Medicine, and Men’s Health.

Do you offer discounts for spouses or families?

Yes! We offer several plans designed for couples and families, and additional members can be added for a discounted monthly fee. Additional members must reside in the same household to be eligible for discounts.

The latest word on discounts is always available on the Direct Primary Care page.

Does the membership cover third party services?

As our membership is not insurance, it does not cover third-party services or products such as hospitals, labs, imaging, specialists, medical equipment, and pharmacies. However, we’re dedicated to assisting our members in finding cost-effective options when external services or referrals are necessary. It’s always our goal to guide and support our members throughout their healthcare journey, ensuring they receive quality care at reasonable prices.

Is this an insurance or cost share plan?

No, the Direct Primary Care membership is not an insurance or cost share plan. It’s a direct care model where patients pay a monthly fee for unlimited access to a primary care provider without involving insurance or government intermediaries.

Have more insurance questions?

You’ve found it!

All the insurance questions answered in one place.

Insurance in a nutshell:

We don’t bill insurance for our Direct Primary Care membership. We do bill Medicare and Medicare Advantage for our Medicare Concierge members, but only for office visits, procedures, and other care Medicare covers. Likewise, we do not bill insurance for our other programs such as Weight Loss, Functional Medicine, or Men’s Health.

Will my insurance or Medicare cover my membership fee?

Most insurance companies and Medicare don’t cover Direct Primary Care (DPC) or concierge-type services. Generally, it’s unlikely that your monthly membership fee will be reimbursed.

Will insurance cover third party services ordered by you?

Our licensed providers can write prescriptions, refer to specialists, and more, which insurance will usually cover if they deem the care medically necessary. If you’re unsure about coverage for products and services from unaffiliated third parties, it’s best to check with your insurance provider before committing to care.

A perk of partnering with us? We help you navigate modern healthcare’s intricacies. While we don’t deal with insurance directly, we can assist with pre-auth forms and can guide uninsured patients to lower-cost medication, lab, and imaging options, and even work with you to find specialists that offer cash pay discounts.

Is DPC or Medicare Concierge a substitute for insurance?

No, a DPC membership isn’t an insurance replacement. It offers extensive primary care services, but we still recommend you have insurance or a cost-share plan for major medical events, hospitalizations, and unaffiliated third-party care and services.

For those on Medicare, our Medicare Concierge plan enhances your Medicare experience, ensuring faster appointments and direct provider communication.

As we aren’t an insurance alternative, it’s wise to have a coverage plan in place.

Don’t have insurance?

We suggest a low-cost, high-deductible plan. There are also cost share programs that will cover certain expenses. But even without insurance, we’re here for you. Being a member means collaborating with a provider dedicated to your well-being, and we’ll help you find affordable medication and service options.

What if I have Medi-Cal?

Unfortunately we are unable to offer direct primary care memberships to Medi-Cal patients due to regulatory complexities. You may participate in our other programs that are not covered by insurance, such as Weight Loss or Men’s Health.

Still have questions? Feel free to schedule a discovery consultation and we’ll be happy to help.

What conditions do you not treat? Do you accept all patients?

Patients from all walks of life are welcome to take advantage of our memberships and services.

It is important to note that while we offer a wide range of primary care services, we may not be the best provider for certain treatments or conditions that require specialist involvement. Some examples include chronic pain management and cross-sex hormone therapy.

We can certainly serve as the primary care provider for a patient undergoing specialized treatments, with the mutual understanding that we would refer a patient for concerns we believe require specialist care.

Direct Primary Care can be a good fit for many people, and we’re always open to discussing individual situations to see if they mesh well with our offerings. If you have any questions or concerns, please schedule a discovery consultation.

Do you offer plans for businesses?

We recognize the importance of providing quality healthcare for small businesses.

We’d love to discuss how an employer-sponsored direct primary care plan can save you and your employees money while providing access to quality, timely care.

Please schedule some time with us to discuss how this innovative solution can work well for your business and employees!

Do you have a price list for in-clinic medications or procedures that cost extra?

Yes. Please request one at the office or schedule a call with us if you have a question about the cost of in-clinic medications or procedures.

We try to secure the best prices for supplies and medications and endeavor to pass those savings onto you.

FAQ: Medicare Concierge

Why is Medicare Concierge waitlisted?

We’re currently scaling our clinic to best support all of our members, and as such we’re limiting the number of Medicare Concierge patients that we intake each month. If you are interested in our memberships, please join our wait list and we’ll reach out when we’re onboarding new Medicare Concierge members. Thank you for your patience!

What is Medicare Concierge?

Medicare Concierge is a membership service designed specifically for Medicare or Medicare Advantage patients. It offers many of the same benefits of a direct primary care (DPC) model, allowing for enhanced services and care beyond what traditional Medicare offers.

Unlike DPC membership, we bill Medicare for services.*

To the member, the experience should be as seamless as it is for a DPC member: simplified access to care when you need it!

It’s important to note that a DPC membership, while similar to concierge medicine, is much more affordable, and doesn’t include after-hours care. Typically, services that offer such care charge between $5,000 and $10,000 a year.

Interested but not sure if it’s right for you? Schedule a discovery consultation to learn more!

* Some in-clinic medications, tests, or procedures not covered by Medicare will be available to you for the same up-front price available to our DPC members.

How is Medicare Concierge different from Direct Primary Care?

Direct Primary Care (DPC) and Medicare Concierge are both designed to make it easier to contact your provider, get appointments when you need them, and have longer, more in-depth consultations.

In practice, members of the two plans would experience the same simplified access to quality care.

The primary distinction lies in how we, the provider of care, must handle insurance. Due to regulatory requirements, we bill Medicare for specific services under the Medicare Concierge membership.

How does the Medicare Concierge plan benefit me more than just having Medicare?

Our Medicare Concierge plan bridges the gap between what Medicare offers and what our patients truly need. With this membership, patients can schedule same or next-day appointments, receive more time with providers, have priority access, reduced waiting times, and enhanced communication. It’s designed to maximize the quality of the care you receive while offering benefits similar to a direct care model.

For example, while Medicare allows a lot of freedom to choose your own provider, often the earliest appointment with that provider is weeks, or even months, off. In our view, that’s just not how healthcare is supposed to work.

If I have a Medicare Concierge membership, do I have access to all the other programs?

While the Medicare Concierge membership is separate from our specialized programs, members do receive exclusive discounts for our other services like Weight Loss, Functional Medicine, and Men’s Health.

Can I enroll if I'm "dual eligible" (Medicare & Medi-Cal) or have a Medicare HMO plan?

Regrettably, due to regulatory complexities, we cannot offer Medicare Concierge memberships to “dual eligible” aka “Medi-Medi” patients.

While we can offer memberships to those who have a Medicare HMO plan, some referrals and orders that would be covered by the HMO may need to be approved by them.

Our other programs such as Weight Loss, Functional Medicine, and Men’s Health, are available to all.

Are discounts available to DPC members also available to Medicare Concierge patients?

We generally offer the same discounts to both memberships, but occasionally there will be differences. For example, if Medicare covers a particular treatment, such as a Kenalog shot for allergies, you won’t have to pay for that optional service.

For services and products not covered by Medicare, we’re pleased to offer the same discounts we offer to our DPC members.

FAQ: Weight Loss

I've tried everything. Why are your weight loss programs different?

We get it. Trying to lose weight can be frustrating and after a while all the programs seem the same. Overpromise and underdeliver, right?

We’re different.

Before we recommend anything, we take a deep dive into your health history and past efforts at weight loss. We’ll recommend traditional medical labs, functional medicine tests, and add in a body composition scan (because we all know BMI doesn’t really tell us much of anything). Ever start a fad diet and wonder why it didn’t work for you? Stop guessing about what foods cause inflammation and thereby hamper your best efforts.

Once we know your BMR – basal metabolic rate – we’ll know how many calories you burn while at rest. This is crucial information when designing a weight loss program that will actually work for you.

Once we’ve collected the data from tests, lab work, and the scan, we’ll collaborate with you on a plan that will create lasting results. Whether you choose a natural path or add in medications, we’ll work with you to get you to where you want to be.

At the end of the day, we have an absolute commitment to understanding the whole person, and we prioritize long-term health and sustainability.

If I'm a member of your DPC, do I get a discount on a weight loss program?

All members receive discounts on our other programs. Just ask us what our current offers are!

Why can't I just take medications for weight loss?

While GLP-1 analogues and other medications can be a great adjunct to a weight loss program, they aren’t the magic bullets we’ve been led to believe. This can be especially problematic if you get a subscription from an online clinic and never receive labs, a quality consultation and follow-up care.

That said, our Weight Loss programs may include medications if you and your provider mutually agree that they are needed to achieve lasting results.

The key is to ensure that any weight loss medications are part of a more comprehensive plan. Are you getting more exercise? Changing key dietary habits? Are your stress levels under control? And is this or that particular drug even appropriate for you?

The worst thing you can do is start to take a medication without a solid plan in place. You certainly don’t want to start taking a medication and having your body adjust to it! You’ll be back at square one, except the same weight or heavier and on an expensive drug.

If you’re ready, we’ll help you craft a sustainable, holistic plan specifically tailored to your body, lifestyle, and goals!

FAQ: Functional Medicine

So... what is functional medicine, anyway?

Functional medicine is a patient-centered approach to health that seeks to identify and address the root causes of diseases rather than merely treating the symptoms. By understanding the unique genetic, environmental, and lifestyle factors that contribute to health and disease, it allows us to develop highly personalized treatment plans to promote optimal wellness.

Learn more on our Functional Medicine page!

How is it different from traditional medicine? Is it a replacement for primary care?

While traditional medicine often focuses on managing symptoms, functional medicine strives to discover and treat the underlying causes. In short, traditional medicine is very good at solving specific issues, but tends to “paper over” the root cause. Functional medicine seeks to unearth these causes and treat them directly, thereby lessening the need to treat the symptoms.

This holistic approach leads to a more comprehensive picture of your health, and allows for more targeted and effective treatments.

As such, functional medicine complements primary care rather than replacing it. While primary care addresses general health needs, functional medicine provides an in-depth analysis and treatment plan for complex, chronic conditions. The key is to ensure primary care practices are employed to solve primary care problems, such as an active infection, while functional medicine practices are employed to solve functional medicine problems, such as why infections are occurring more often than would otherwise be expected.

What sort of tests are used in functional medicine?

Functional medicine often employs standard medical lab work but adds specialized tests to gain a comprehensive understanding of your health. These tests help us identify imbalances, deficiencies, and other factors contributing to health issues.

For example, most traditional medicine doesn’t examine the microbiome in your gut, which we now know is essential to understanding your overall health. It’s now understood that an unbalanced gut microbiome can make it more difficult for you to lose weight. And every day we’re learning more and more about how gut health can impact mental health and well-being.

Trying to solve chronic conditions without understanding the foundational causes often leads to expensive and unnecessary treatments that ultimately fail to solve our problems.

To this end, we use a variety of tests that aren’t appreciated by the wider healthcare community even though they are based in scientific research.

FAQ: Men’s Health

Does my insurance cover Men's Health?

As a general rule, most insurance plans do not cover Men’s Health programs such as hormone replacement therapy unless specific medical criteria are met. Many men will experience symptoms well above this threshold. We recommend reaching out to your insurance provider for information specific to your plan.

What if I don't qualify for HRT? What are my options at that point?

Various factors might make one ineligible for hormone replacement therapy (HRT), ranging from medication contraindications to specific health concerns or weight issues. If HRT isn’t suitable for you, there are several paths forward. Embracing a healthy lifestyle, including weight loss, can naturally boost energy and help your body regulate hormone levels. Enrolling in our Direct Primary Care (DPC) membership or weight loss programs can improve overall health, potentially paving the way for HRT in the future. Our primary aim is to ensure your overall well-being, and we’ll guide you towards the most beneficial healthcare path for you.

FAQ: The Fine Print

Hey, you said your solution was simpler! What's with the fine print.

Yeah. We get it. We’ve tried to ditch as much needless complexity as we could. But, hey, healthcare is one of the most regulated “industries” on the planet. We’re trying to offer something that’s relatively new. And, you know, be less industrial about it. To us, you’ll be a person, not a number.

Technically, this section isn’t even a FAQ. More of a… list of fine print. Not exhaustive. Nothing you read on this website is conclusive as to your care. None of this is medical advice. We are not your provider until we’ve signed a contract to be your provider, and you’re not a patient until you sign our contract to be a patient. Any legal obligations between us will be governed by those contracts, not by something you read on this here website.

That said, we aim to be as open and forthcoming about our business practices as humanly possible.

Yeah, told you it was fine print.

Privacy Policy

Your privacy is important to us. This Privacy Policy explains how we collect, use, protect, and handle your personal information and your rights in relation to this information.

1. Information Collection and Use

We collect information from you when you visit our website, register on our site, place an order, subscribe to a newsletter, fill out a form, or enter information on our site. The types of information we may collect include your name, email address, mailing address, phone number, and other contact details.

We use this information in the following ways:

  • To personalize your experience and to allow us to deliver the type of content and product offerings in which you are most interested.
  • To improve our website in order to better serve you.
  • To allow us to better service you in responding to your customer service requests.

2. Cookie Usage

Our website uses cookies – small files that are placed on your device to help the site provide a better user experience. In general, cookies are used to retain user preferences, store information for things like shopping carts, and provide anonymized tracking data to third-party applications like Google Analytics. Our third-party service providers such as Calendly will also use cookies if you make an appointment from an embedded scheduling app on our website.

Cookies are designed to make your browsing experience better. However, you may prefer to disable cookies on this site and on others. The most effective way to do this is to disable cookies in your browser. By continuing to use our website, you consent to our terms and agree that we may store cookies on your computer unless you block them, and acknowledge that blocking them will disable certain functionality.

Our website and business operations are California based. We do not serve users outside of California, and do not comply with international regulations. 

3. Protection of Information

We do not sell, trade, or otherwise transfer your Personally Identifiable Information to outside parties. This does not include website hosting partners and other parties who assist us in operating our website, conducting our business, or serving our users, so long as those parties agree to keep this information confidential. We may also release information when its release is appropriate to comply with the law, enforce our site policies, or protect ours or others’ rights, property, or safety.

4. Third-party Links

Occasionally, at our discretion, we may include or offer third-party products or services on our website. These third-party sites have separate and independent privacy policies. We, therefore, have no responsibility or liability for the content and activities of these linked sites.

5. Consent

By using our website, you consent to our privacy policy.

6. Changes to Our Privacy Policy

We reserve the right to update or change our Privacy Policy at any time and you should check this Privacy Policy periodically. Your continued use of the service after we post any modifications to the Privacy Policy on this page will constitute your acknowledgment of the modifications and your consent to abide and be bound by the modified Privacy Policy.

7. Contact Us

If there are any questions regarding this privacy policy, you may contact us.

We do not offer insurance products, and our memberships are not insurance.

Orcutt Direct Care, an Advanced Practice Nursing Corp., is not in the business of offering or selling insurance or cost share plans, and none of our memberships, services, or programs are insurance, or designed to be a replacement for, insurance.

In fact, we recommend you have, at minimum, a high deductible insurance plan to cover medical costs that we can’t help you with, such as ER and hospital visits, ambulance rides, specialists, medications, labs, imaging, and the like. If you don’t have insurance, there are cost share plans that can offset the costs for care we don’t provide to you.

We do not bill insurance.*

Fine print with an asterisk. That’s great.

We do not bill insurance for services offered under our Direct Primary Care membership, nor our other non-membership programs.

Membership fees for Direct Primary Care or Medicare Concierge plans are not typically reimbursed by insurance.

Now for the asterisk: we do bill Medicare or Medicare Advantage for office visits and procedures for our Medicare Concierge members. Offering a Medicare Concierge membership does add a little complexity, but we believe it’s important for Medicare patients to have this option.

DPC practices often charge much more for people over 65. We didn’t want to do that.

The Medicare Concierge membership is not a Direct Primary Care membership.

It’s important to note that while both the Medicare Concierge plan and the Direct Primary Care (DPC) plan are designed to offer very similar experiences, they are legally distinct membership plans.

The Medicare Concierge plan is a concierge plan in that you are paying exclusively for enhanced access. Yes, we’ll offer the same basic care DPC members receive, but you’re not paying for the care per se (such as office visits, minor procedures and the like).

DPC members are paying for both enhanced access and the care directly.

You made it to the end!

Hey, we’d be impressed if you read all that.

Now that you know everything there is to know about our memberships and programs, you can sign up today!

Interested, but still have questions? Schedule a free, no-obligation discovery consultation to learn more!