Do you accept insurance?
We do not have ties with insurance, Medicaid or Medicare in order to give you more time, better care, and lower prices. As we are “out-of-network,” please check your benefits for payment options if you choose to submit a claim. We provide a receipt and make available to our patients documentation of the services provided if they need this to submit claims. We make no claims or guarantees of coverage by your insurer. Medicare and Medicaid do not allow you to submit claims for our services.
Although your membership fee isn’t covered by insurance, you have the option of using your insurance for MRIs, prescriptions, labs, etc. Or you can purchase labs through the practice at a highly-reduced cash rate. If you have private insurance, we’ll give you a receipt with all the information you need to submit a claim form to your insurance company, to get reimbursed directly. The amount of reimbursement you receive will depend on your contract with your insurance company.
We like to say everything done within the walls of or by the practice is covered by our fees. If you need to go outside the office – like for labs, blood work, or specialists you can use insurance like you normally would. Dr. Stock retains his full referral capabilities and can actually offer much-less-expensive cash pricing for those with high deductibles, helping you drastically reduce healthcare costs.
Click here to find out why this model is different.
Why pay directly when I have insurance?
Studies show savings of $260 per patient per month with DPC compared to insurance-based practices. These savings come from reducing ER visits, hospital visits, inappropriate use of technology and referrals. Because you have full access to me, I can be the one to guide you in your healthcare decisions. By joining a DPC practice like mine and having all of your primary care needs covered at all times, you then may have some options to move to an insurance plan with lower premiums and higher deductibles. I would suggest talking to an insurance professional for your options.
Some Medicare Advantage plans will assign you another physician who will remain inactive in your case. Also Medicare HMO plans DO require in-network primary care doctors. I’m happy to work with them if you want me to.
Especially for Medicare patients, PureHealth Functional Family Medicine will provide health services that are vastly expanded from what you are accustomed to. As a result, you may not need as much Medigap insurance and may be able to drop down to a deductible Medigap plan to save money – especially if your Medigap premium is maxed out. We recommend you contact a Medigap consultant to explore ways to save money.
How long is my Contract?
Our service contract is for one year. All contracts are automatically renewed unless a 15-day notice is received by us not to renew. You can cancel your membership with 15 day’s notice and any future payments will cease.
Can I take your membership fee out of my Health Savings Accounts (HSAs)?
Always check with your tax advisor, but our fees are designed to be compliant with health savings, flexible spending, and health reimbursement accounts. We are happy to provide you with an invoice and/or submit a notice to your employer if any questions arise about our programs. While a membership is a qualified medical expense, we do recommend paying with an HSA.
What forms of payment do you accept?
You may pay with cash, credit, or check. We require patients to keep a credit card or bank account on file.
If I sign up today, when would I get charged?
If you sign up for a membership online, you will be charged immediately. Hourly rates are due at the time of service, but are calculated to the nearest 5 minutes and only on the time doing medical thought, not administrative duties.
What should I expect at my first appointment?
We schedule two and a half hours for your first appointment so that we can take an extensive history, exam, and a discuss options to optimize your health. If it takes less than two and a half hours to do all that, you won’t have to pay for the whole time; you’re only charged for the time you use. If you are fairly healthy and have no chronic conditions you likely won’t need that much time. If you can only afford a shorter time please let us know when you schedule, and we’ll do as much as we can in the time that meets your budget, but we may not be able to address all of your issues.
How much does it cost to see Dr. Stock for my first appointment?
This will depend on the plan you choose and the complexity of your case.
Can I change my plan once I select one?
That depends on the plan you chose. You can choose to move to a higher level plan, but there are no refunds for the unused part of the year of any plan. If you are uncertain which plan is best for you, choose the lowest level plan. At your first visit, we’ll allow you to terminate that lowest plan and choose a higher level plan, and bill your first visit under the higher level plan.
How long does it take to get my first appointment?
Generally your first appointment will be four to six weeks out from when you sign up and contact us to schedule. We only see two new patients a week, so that our practice doesn’t become too big and we can serve our existing patients. We do have a cancellation list. While you’re waiting for your first appointment, we’ll still handle acute problems should they develop.
Is your practice good for Medicare patients?
Our practice is excellent for the patient with Medicare who wants more care and services beyond what the the government desires. Our Medicare patients pay our practice fees directly, but Medicare coverage remains in place for everything else: specialists, testing performed outside our office and hospitalizations. Your Medicare also covers labs services, as these are performed by an independent lab affiliate. While I don’t accept Medicare payments, I can refer, write orders and prescriptions, and act as your primary care physician, and Medicare will pay for any services that I order, just like they would for a Medicare-accepting provider.
Some Medicare Advantage plans will assign you another physician. Medicare HMO plans DO require in-network primary care doctors. I’m happy to work with any of them if you want me to.
Especially for Medicare patients, PureHealth Functional Family Medicine will provide advice that is vastly expanded from what you are used to in primary care. You may not need as much insurance or may be able to drop down to a deductible medigap plan to save money, especially if your medigap is maxed out. We recommend you contact a healthcare consultant to explore ways to save money.
What if I need to go to the hospital?
While I don’t admit patients to hospitals, I’m happy to consult with you or your attending physician while you are in the hospital. As your private physician, I would like to be involved in your hospital care—whether to speak to the emergency room physician or the in-patient doctor to assist in your care. I am also happy to keep in touch with your families (with your written permission!) during your stay and help arrange for your care after you return home.
What about labs, imaging, prescriptions?
I can order labs and imaging just like any in-network provider. Whether your insurer will cover those or not is determined by your insurer. Medicare always accepts orders from non-Medicare accepting providers for services that they cover. Most insurers do to, but check with your insurer. We also have contracts with local labs where you can buy labs through us a deep discounts, less than you can buy them paying the lab directly. This is especially helpful for those without insurance or high-deductible insurance. However, if you still would like to submit to your insurance you are welcome to do so. I can provide you with those options that allow you to make the right decision based on your situation.
What about after the office closes?
We’re available to you after-hours for urgent problems. You will have access to communication tools that will allow us to talk and video chat, and send pictures in real time. While I cannot provide emergency care after hours, I can help you decide whether you want or need emergency care. The on-call service is not for convenience or comfort care, but only for questions that can’t be addressed with the same outcome when the office re-opens. On-call consultations are always billed at $300/hour regardless of your plan, with a minimum 5-minute charge for each call.
How are office visits handled?
It’s easy! Request a visit either online or by phone and come in to the office and see me. We can also do your visit by video or phone if you prefer. The choice is yours (except for the state mandated face-to-face yearly visit), but if I feel I can serve you better in the office I’ll let you know.
How can I be sure you will have time for me if your access is unlimited?
I am not the first practice to be structured using this model of care. My practice is designed to be viable at about 600 patients. Keep in mind that a normal practice has roughly 2000 patients-per-doctor. My main priority is you, and I want to make sure I’m available for you while maintaining little-to-no wait, same-day or next-day visits, as well as office visits that are not rushed. And remember, if I tried to take on too many patients, they would start cancelling their memberships, just like you can.
Why is direct patient care better?
Conventional insurance-based medical practices are unwieldy, with many more employees and time spent just on billing and collections. Because of this, doctors are forced to see 35+ patients a day, allowing little time for each visit and creating wait times many times over an hour. Many times, the cost of sending the bill to six different places is more than the fee itself. By letting doctors be doctors, and not business centers, the cost of an office visit goes way down. Even more importantly, insurers, employers and government programs pay doctors to give the advice they want you to have, and financially punish them for giving advice they don’t want you to have. By working directly for you, my advice is not coerced by these sources.
Do you have evidence that direct primary care costs less?
Numerous reports show better care and cost-saving throughout the United States. In North Carolina, DPC saved $1.28 million in health care claims in one year for 2000 patients. Less paperwork for doctors means more time to spend with patients as needed to manage medical conditions. More time means more access and more thought, which means fewer specialist referrals, hospital admissions and ER visits. In insurance-based medical clinics, 43% of the day is spent on needless paperwork.
Can I see you without signing up for a full membership?
No, you have to have signed a contract under one of our membership plans. Indiana law states that if I don’t have a contract with you, I become an insurance company.