WHY SHOULD I JOIN PRIME PLC?
Because you want a doctor who will spend time with you, truly get to know you, and always remember you, your history and your needs—a doctor who will guide you and your healthcare choices. If you yearn for the days of old-fashioned primary care, when your doctor knew you and had time to spend with you, this is the practice for you.
WHAT IS COVERED IN MY MEMBERSHIP?
Direct primary care covers your primary care physician’s professional services — the evaluation and management of your medical problems. Your membership includes an annual physical exam and up to five additional visits per year. Need more than that? Come on in for only $30 a visit.
If you have a problem that reaches beyond the scope of usual and customary primary care, your physician will carefully refer you outside the practice. As part of your membership, your doctor will review the results of all of your evaluations and testing, answer any questions you may have and coordinate care with your specialists.
WHAT IF I JOIN AND DON’T LIKE IT?
We strive to make all our patients happy, but if for some reason you are not satisfied, you can cancel your membership at any time. You will only be charged for the portion of the month you were a member prior to cancellation.
IS THIS JUST A MONEY-MAKING VENTURE?
No. It’s the only viable way to maximize our time with you. We can’t practice medicine the way we’d like in 15-minute intervals mandated by insurance companies.
WHAT IF I DON’T HAVE THE MONEY FOR THIS?
We may be able to help. Our plan is to provide free care to 10 percent of our members in financial need. For those of you blessed with a good income, please know that a portion of your membership fee will help provide care for those in our community struggling on a daily basis.
DO I STILL NEED INSURANCE?
Yes. The biggest reason to keep health insurance is for the lab tests, medications, radiology studies, specialty evaluations, surgeries, and hospitalizations you might need—services not covered by direct primary care. They are usually covered by your insurance, but with hundreds of different insurance products out there with thousands of rules, please remember to check with your insurance company.
WILL DR. DREGER BE “IN-NETWORK?”
No. Direct Primary Care payments are not covered by “in network” agreements with insurers. As part of Prime PLC, Dr. Dreger will not participate with any insurance company.
WILL PRIME PLC TAKE MEDICARE?
Direct Primary Care payments are not allowed for Medicare providers. Medicare should still cover lab tests, radiology studies, consultations and hospitalizations for those patients with Medicare.
CAN I SUBMIT THE COST OF PRIME PLC MEMBERSHIP TO MY INSURANCE?
Insurance companies do not recognize Direct Primary Care costs as an “allowable charge.” They will not reimburse any portion of the membership fee. All payments to Prime PLC cannot be claimed against insurance, and that includes Medicare.
WHAT IF I HAVE A HIGH DEDUCTIBLE PLAN?
Prime PLC is a wonderful choice for patients with a high deductible plan. You’ll have ready access to your own doctor for a simple monthly fee. Some Direct Primary Care patients will change their insurance plan so that the net cost of their insurance + direct primary care is the same as before they joined a Direct Primary Care practice.
CAN I APPLY MY MONTHLY PAYMENT TO MY DEDUCTIBLE? WHAT ABOUT A HEALTH SAVINGS ACCOUNT OR FLEXIBLE SPENDING ACCOUNT?
Sadly, no. We wish it were different, but Direct Primary Care costs cannot be applied to deductibles, Health Saving Accounts or Flexible Spending Accounts.
TESTING & HOSPITALIZATION
WHAT ABOUT LAB TESTS?
Our practice has a contract with Quest labs. If your insurance participates with Quest, we will draw your labs here and ask Quest to bill your insurance. If your insurance participates with LabCorp, then your doctor will give you a prescription to take to a participating lab. They are usually covered by your insurance, but with hundreds of different insurance products out there with thousands of rules, please remember to check with your insurance company. Finally, Prime PLC will offer lab tests at cost. Payment is due at the time of service.
Pricing Comparison for Labs
We are happy to order your labs so that your insurance company is charged. But, if you have a high deductible plan, that can mean a lot of money from your wallet. At Prime PLC, you can also pay for your labs directly – at a fraction of the cost. Take a look at the Prime PLC difference:
IF I NEED TO GO TO A HOSPITAL, WHO WILL ADMIT ME?
You will be admitted by a hospitalist, not Dr. Dreger. We will certainly remain actively involved, talking to the doctors, reading your studies and helping to explain your care and tailor it to you. But we will no longer admit patients to the hospital, Dr. Dreger will be out-of-network for your insurance and out-of-network physicians can cause the cost of a hospitalization to skyrocket.
What about vaccinations?
Vaccinations are not included in membership. Patients can choose to pay cash for a vaccination at the time of service, or receive a prescription to take to their pharmacy where the pharmacy would bill their insurance.
FOR CURRENT DR. DREGER AND DR. AMEDEO PATIENTS, IS MEMBERSHIP AUTOMATIC?
No, you need to sign up. And our limited number of memberships are available on a first-come, first-serve basis. If you are interested in staying in the practice, we encourage you to sign up early.
CAN I STILL BE SEEN AT THE PRACTICE IF I AM NOT A MEMBER?
Not after Dr. Dreger’s contract with your insurance company ends. If you do not wish to be a member, then simply contact us for your medical records. Please be aware there is a $25 fee for copying those files.
WILL PRIME PLC HIRE MORE PHYSICIANS?
Eventually. Dr. Dreger is committed to expanding the practice.