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Frequently Asked Questions
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What is Direct Primary Care?Piney Grove Family Medicine (PGFM) represents a personalized healthcare approach centered on the patient and provider relationship. We do not participate in insurance plans. Instead, we offer an affordable monthly membership fee that encompasses all of your primary care office appointments. As a member, you also enjoy added perks such as on-site laboratory services, which may come as a surprising source of long-term savings.
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How will this save me money?You can reduce the need for many visits by directly reaching out to us through email and text, which is a feature typically unavailable in traditional healthcare practices. We've successfully negotiated favorable rates for laboratory testing. Better yet, we pass these cost savings directly on to you.
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I am in pretty good health. Is Piney Grove Family Medicine right for me?Good health is what we all strive for. Chances are, however, you will at some point get sick or injured. Piney Grove Family Medicine will be there for you, able to give you the care you will need without long waits or expensive Urgent Care co-pays or ER fees. With out-of-pocket deductibles close to or over $5,000, it doesn’t take much more than a trip or two to Urgent Care or the ER for the cost of Piney Grove Family Medicine to be well worth the low monthly fee.
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Is this the same as concierge medicine?Yes, sort of… but with a few distinct differences. Concierge medicine has traditionally been described as a medical practice for wealthy patients who pay an expensive premium of upwards of $5,000 annually to see their provider. Concierge providers typically still participate in insurance, so the rules and restrictions of health insurance are still in place. Piney Grove Family Medicine offers patients concierge-like service and personalized primary care. Piney Grove Family Medicine offers membership fees that are much more affordable and does not participate in insurance. This makes personal healthcare without hassles affordable to everyone. Some have called it "concierge medicine for the average person."
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What happens if I need to go to the hospital or a specialist?Our providers can coordinate a patient’s care with the hospital’s team. If you require hospital care, you will likely be under the care of a specialist. Hospital and specialist fees are not covered by our membership. Other hospital charges and associated costs will still apply. That’s when your insurance will come in. Your Piney Grove Family Medicine provider will then pick up your care upon discharge. They will work closely with the specialists and hospital team upon admission and discharge so that there is continuity in all of your care.
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How much does membership cost? Is there an enrollment fee?See our prices on our membership page. We charge a flat monthly fee and in exchange, you get primary care office visits, close to wholesale prices on laboratory testing, and a whole lot more. Yes, there is a $50.00 initial enrollment fee.
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What does the membership fee cover?The fee covers all of the office visits you may need with no copay, ever. This includes the following: annual wellness exams, sports physicals, school physicals, chronic care office visits, follow-up visits, basic office procedures, and treatment of acute illness or minor injuries, all with minimal wait times in the office. The fee also covers direct communications with your provider including phone and telehealth visits. Our members also have access to discounted laboratory pricing not included in the membership fees.
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What medical conditions do you care for?We treat all kinds of common everyday problems like colds, flu, strep, rashes and injuries. We also treat more complicated long term medical problems like adult diabetes, high blood pressure, high cholesterol, depression, anxiety and thyroid disorders.
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Do you treat chronic pain?No, we do not prescribe narcotics for chronic pain. But we will work with you in getting you the care you need whether that be a referral to physical therapy, orthopedics, pain management, neurology, etc.
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What if I need medical attention while I’m away from home?We'll be there for you during office hours via phone, email, or text. Many illnesses can be diagnosed and treated with a simple conversation. We’ll help you locate the nearest pharmacy and order the medications most appropriate for your circumstances. If you need to go to the hospital or seek other medical attention while away from home, we can advise you on that as well.
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Are my medical records ever shared with government agencies, insurance carriers, pharmaceutical companies or employers?In a nutshell, no. Patient privacy is a natural benefit of this medical model, and we maintain high standards. We will never provide any third party with a copy of your records unless you specifically ask us to do so or if Piney Grove Family Medicine is legally required to do so.
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When do I pay my fees for non-covered labs and procedures?Charges will be added at the time of service and applied to your preferred method of payment. In other words, you can pay for those at the time of service with cash, check, or credit card.
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What if I decide to cancel?We expect to have an open, honest, respectful relationship with you. If you have voiced a complaint that we cannot satisfy together, we will gladly allow you to cancel your membership. We do request a 30 day written notice of cancellation. If you choose to rejoin, re-enrollment fees will be applied. ($150/re-enrollment).
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Do you accept insurance?No, happily no! And that is a bonus for both you and us. Perhaps the most critical distinction in our model of care is that the patient & and provider are front and center. We do only what is best and right for every patient. When a patient and a provider work together like a TEAM, healthcare becomes simple. And when all the red tape is removed, healthcare becomes affordable. Think of your auto insurance. You use that for emergencies and accidents, right? You don't expect your auto insurance to cover oil changes and tire rotations. Now apply that same logic to health insurance. Use health insurance for the "big stuff" like surgery or hospitalizations. But primary care... Well, that's routine maintenance, much like your car's oil change. So, make it simple and leave health insurance out of the exam room.
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I don't have insurance - can I still join?Yes, we take care of any patient regardless of your insurance situation. Since we work completely outside of the insurance system, none of what we do here is eligible for insurance reimbursement.
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As a patient, will I still need health insurance?Yes. We recommend that you do have insurance to cover those big, unexpected expenses. Piney Grove Family Medicine is not an insurance plan, nor does it replace it. Ideally, we encourage our patients to carry a high deductible, major medical plan or a plan with a health savings account. Having a high deductible or a share plan ensures financial help should hospitalization or referral to a specialist be necessary. You should consult with your insurance provider to help you find a plan that works best with our model and that will meet your specific needs.
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Is the membership fee eligible for Health Savings Account or Flexible Spending Account reimbursement?This is a question that has a tough and confusing answer. HSAs & FSAs are a smart way to pay for your health care needs with pre-tax dollars. IRS regulations make it pretty clear that all DPC services are covered medical expenses reimbursable through HSAs and FSAs, but at the same time, the IRS claims that DPC memberships are health plans, and therefore fees are not reimbursable when employees combine DPC with any other “health plan” (like the catastrophic or high deductible insurance most DPC patients need). It gets even more complicated as the Affordable Care Act and many state laws have clearly stated that DPC plans are not insurance. The issue is being addressed at the federal level with legislation called the Primary Care Enhancement Act. In the meantime, the best thing to do is check with your health plan, insurance broker, or employer.
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If I have Medicare, can I still join?Yes. However, your monthly membership fee cannot be submitted to Medicare for reimbursement. You will be asked to sign a waiver that declares that neither you nor your provider will directly bill Medicare for your membership fee. Medicare and Medicaid supplemental insurance will still cover medical costs that you incur outside of Piney Grove Family Medicine. For example, prescriptions that you fill at an outside pharmacy, labs done at an outside lab, hospital charges, physical therapy, x-rays, and scans can still be covered by your Medicare. You do not lose your Medicare coverage for other medical needs just because you are a patient of Piney Grove Family Medicine.
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I already have insurance, won't I be paying twice for the same services?In many ways, patients already are paying twice: co-pays, co-insurance, deductibles, non-covered services, out-of-network charges, the list goes on… The average family of four pays over $5,000 in out-of-pocket medical expenses over the course of a year. With Direct Primary Care, like Piney Grove Family Medicine, you can save hundreds, even thousands of dollars in out-of-pocket costs. Become a patient at Piney Grove Family Medicine and get more value for your healthcare dollars.
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