FAQ
What is Direct Primary Care?
Direct Primary Care (DPC) is an innovative alternative payment model improving access to healthcare with a flat, affordable membership fee. No fee-for-service payments. No third party billing.
The defining element of DPC is an enduring and trusting relationship between a patient and their primary care provider. The innovative model transforms the way we practice medicine by allowing us to prioritize our relationship with our patients. There is no one behind the scenes making decisions about your care. By eliminating the restrictions and red tape created by the insurance companies, the care becomes truly about you and your health. You and your doctor are in the drivers seat of your health journey. In the DPC model, patients have extraordinary access to a physician of their choice and physicians are accountable first and foremost to their patients. DPC is embraced by health policymakers on the left and right as a model that results in satisfied patients and doctors.
Is concierge medicine the same as Direct Primary Care?
The terms are often used interchangeably and essentially refer to the same principles. Both models provide direct access to the provider and personalized care, however the concierge model bills insurance while also charging a membership fee. DPC does not bill insurance, and the membership fee is usually dramatically less than for a concierge membership. We like to think of Direct Primary Care as concierge level care for the everyday person.
What if I’m healthy and only see the doctor once or twice a year? Is Torrey Pines DPC for me?
Absolutely. One of the best aspects of a DPC clinic is the opportunity for prevention. Our goal is to prevent disease rather than react to disease. In the direct primary care model, we take time to discuss lifestyle choices and family medical history with you that may be causing current or future problems.
Many of us have medical conditions that start small and we often don’t see a doctor because of the cost and inconvenience. Unfortunately, those seemingly insignificant issues can lead to serious concerns later on -- addressing them early is crucial. That’s why we’re here.
And chances are, at some point, you will get unexpectedly sick or
have an inconvenient accident or injury. Torrey Pines will be there for you, able to give you the care you need without long waits, expensive urgent care co-pays, or ER fees. One saved ER visit usually pays for at least a year’s membership fees.
Does Torrey Pines DPC accept health insurance?
No, which we’re really excited about! We employ the Direct Primary Care model using a flat, monthly membership fee. We don’t participate in insurance so there is no middleman. Our only obligation is to you, the patient. We save enormously by cutting out the time and expense devoted to insurance companies’ endless paperwork and clerical demands. We devote our resources where they belong—in taking care of you.
As a member of Torrey Pines DPC, will I still need health
insurance?
Yes. Torrey Pines DPC is not an insurance plan, nor does it replace insurance. We recommend carrying insurance to cover you for hospitalizations, surgeries, and other care that is not included in the membership fee. Since they have no need for primary care coverage, many DPC members find that they save considerably by obtaining a high-deductible insurance plan.
Does my DPC membership count towards my deductible?
No, Direct Primary Care membership fees do not count as an eligible health expense towards your insurance deductible.
If I have Medicare, can I still join Torrey Pines Direct Primary Care?
Yes! You only need sign a one-time waiver declaring that neither you not your doctor will directly bill Medicare for our services. Medicare will still cover any laboratory testing, imaging, medications, or hospitalizations prescribed by our office. Due to insurance restrictions we cannot accept Medicare patients with a Medicare Advantage plan.
Can I submit my Torrey Pines DPC membership to Medicare for reimbursement?
No, your membership fee cannot be submitted to Medicare for
reimbursement.
What happens if I need to go to the hospital or see a specialist?
We seek to prevent or reduce hospitalizations and specialty referrals through improved access and our preventative care approach. If you are hospitalized, we will coordinate your care with the hospital’s team.
Hospital care is not covered by our fee. That’s where your insurance comes in. Our providers will work closely with the hospital team upon your admission and discharge so there is continuity in your care. If you need a specialist, we will refer you, leveraging their professional network to find the best fit care for you. In some circumstances, we can communicate with a specialist about your condition and get a treatment plan without you actually seeing the specialist, saving you money and time.
Does Torrey Pines DPC provide pediatric care?
Yes! We care for patients of all ages, newborn and up!
Do you dispense controlled medications for chronic pain or
anxiety?
Torrey Pines DPC does not keep any controlled medications in the clinic.
We do not manage chronic pain and will not routinely prescribe
narcotics or other controlled substances (Tramadol, Codeine,
Hydrocodone, Soma, etc.) on an on-going basis. We recognize
chronic pain management as a specialized field of medicine and
believe long-term treatment of chronic pain should be addressed by a board certified pain management physician in an accredited pain management center.
We do not routinely prescribe controlled substances for the long-term treatment of anxiety. Anti-anxiety drugs such as Xanax (alprazolam), Klonopin (clonazepam), Ativan (lorazepam) and Valium (diazepam) may be prescribed for the short-term treatment of acute anxiety, or on an infrequent "as-needed" basis, but will not be prescribed for routine long-term use. Antidepressants and certain other anti-anxiety medications are not controlled substances and will be prescribed as needed.
What if I need to get an X-ray or other imaging done?
We will help arrange any basic X-ray or advanced imaging test (MRI, CT, etc.) you may need wherever you would like to go. Best of all, we will follow-up the results with you.
Are my medical records ever shared with insurance carriers or government agencies?
Not unless you ask us to. Patient privacy is a natural benefit of this medical model. We will never provide any third party with a copy of your records, unless you specifically ask us to do so or if required by law. Review our Notice of Privacy Practices here.
Can I contact my doctor after hours?
Yes! We understand that illness doesn’t always respect usual
business hours. Therefore, as a member of Torrey Pines DPC you will be given access to your provider through a secure app for urgent concerns that come up unexpectedly after hours.
What if I want to cancel? Will I be obligated to a long contract?
No. If you decide that DPC is not for you (we don’t think you will), you can cancel anytime with 30 days notice — no questions asked. Review our Patient Agreement form here.