What is Direct Physician Care?
Direct Physician Care is a health care delivery model, approved by the American Medical Association, which emphasizes patient care. DPC gets rid of the time limitations that insurance companies place on physician-patient contact (usually 15 minutes), single subject visits ( only one health concern may be discussed per visit) , unnecessary and redundant forms and other ” red tape” that negatively impacts your patient care. In short DPC puts the patient first in patient care.
The Direct Physician Care model provides freedom for the patient and the physician by allowing the physician to provide personal, patient-centered medical care. DPC allows the physician to treat fewer patients by reducing the costs to the physician required by insurance companies’ many, varied, and unnecessary compliance rules. The reduction in the number of patients results in individualized, comprehensive care, and reliable, timely access to that care.
How Does DPC work?
The physicians offering DPC do not accept insurance payments for services. In the case of Partner in Health AZ, this does not apply to Medicare insured patients (excluding all Medicare Advantage Plans). Instead, DPC practices charge a monthly fee which allows the physician to deliver personalized comprehensive medical care.
Why pay a membership fee when I already have primary care through my insurance?
This is the first question many patients have, as the concept of Direct Physician Care is relatively new to Arizona.
Dr. T. believes that your best health care decisions are made between you the patient and her, your physician. Over the past few decades, patient care has taken a backseat to the insurance companies’ bottom line. The constraints insurance companies have placed on physicians in traditional practices have negatively impacted your health care. Many traditional practices restrict office visits to only 8-10 minutes, and require a separate appointment to address each individual issue.
Our goal with this transition to DPC is to provide you with a better patient experience, and exceptional medical care by a board certified physician. By eliminating the insurance middleman and “red tape,” Dr. T. will have more time dedicated to you:
- Quality, thorough and personalized patient visits
- Extended telephone, text and e-mail access to your physician
- After hours and weekend phone calls and office visits available for urgent issues
- Results from testing or labs communicated to patients promptly
- Negotiated, discounted rates for many medications, labs and radiology exams
- In-office lab draws
- Fee-free FMLA/work forms
- Private patient portal for communication, labs and payments
- Coordination with specialists
- Osteopathic manipulation
- Same day & next day acute visits for illness
Who is eligible for membership?
Individuals aged 12 years and over are eligible for membership. Existing patients of Dr. Tymczyna’s will receive priority membership enrollment. DPC Membership is limited and reserved for you when you have completed the enrollment agreement and enrollment fee has been paid. This fee is non-refundable.
Do you accept medical insurance?
No. As of January 1, 2019 we do not accept insurance. Patients are charged a membership fee for physician services.
Do you accept Medicare?
Yes. Medicare as your primary insurance (but not Medicare Advantage Plans such as AARP/Optum/UHC/Aetna) is the only insurance accepted for established patients only.
Medicare patients can join for an annual administrative fee of $125 per person. This administrative fee pays the services that Medicare does not cover, and is due annually on January 1st. This fee is non-reimbursable through Medicare, and is the patient’s responsibility.
Other services such as labs, radiology tests, consultant or hospitalist fees are billed to medicare as usual.
How much does membership cost?
There are two main costs for membership: the one-time enrollment fee, and the monthly membership fee. This membership fee is paid in either one or two payments. If you choose to pay the entire amount at once, it is due on January 1st annually. If you choose to pay in 2 installments, payments are due on January 1 and on July 1st annually.
The one-time enrollment fee:
New patients: $125 per individual or $250 per family (2+ people)
The membership fee is based on your age on January 1 of each year. This fee is paid in either one or two payments.
Membership Fees:
Individuals:
12-24 years old ($30 per month) $360/year
25 – 49 years old ($55 per month) $660/year
50 years and older ($80 per month) $960/year
Family rates:
Includes two adults 26 years or older, plus one or more family member from 12-25 years: ($160 per month) $1,920/year
Will my office visits have a co-pay?
No! Since we won’t be billing your insurance any more, we will not charge you co-pays for your first 6 visits (1 annual physical, and 5 office visits are included in your membership fee.)
What services does the membership fee include?
The membership fee includes an annual physical, five office visits(scheduled during regular office hours), osteopathic manipulation, access to your physician through telephone and email, basic lab tests/routine office procedures, obtaining prior authorizations for medications, completing FMLA/ short term disability forms, access to the Patient Portal for communication with Dr T, accessing your lab/imaging results and options for making payments. A full list of inclusions will be available shortly.
What services are billed separately from the membership fee?(complex skin procedures exclusions)
A separate fee is charged for office procedures. If you require an office visit outside of regular office hours, a $50 Urgent Care fee will be charged. Your membership includes 5 office visits in addition to your annual physical during business hours. A $50 fee will be charged for any visits beyond your 6th visit. Fees for third party lab work, tests and imaging will be charged at a discounted rate, fee schedules will be provided separately.
How does DPC work for lab work, prescriptions and imaging if I have insurance?
Fees for lab work, prescriptions and imaging depend on your insurance plan. Most plans will cover labs ordered by Dr. T, however some HMO plans may not. Most testing can be done at low fixed rates with the local lab and radiology service. If you need these services, a fee scale can be provided. Any costs for urgent care, emergency room, hospital or specialist visits are billed to your insurance plan as usual. If you need an unusual or cost-prohibitive test done and the rate being offered is out of network and unaffordable, we will refer you to another provider within your insurance network to have the test ordered at an in-network fee.
Do I need to have health insurance?
Yes, the DPC membership only includes care we deliver at our office. It is important that you maintain health insurance coverage for care you get elsewhere: for example pharmacy, specialists, and hospital or emergency services.
Are there insurance plans that make joining more difficult?
Yes, HMO plans with Cigna, United Healthcare, Humana, and others that require an assigned primary care physician (PCP), usually require that all tests and prescriptions be ordered by your assigned PCP. So the cost of all tests and prescriptions ordered by your DPC may be your financial responsibility.
Can I be reimbursed from my health plan or health savings account (HSA/FSA) for my membership fees?
Currently, DPC memberships can be paid using your HSA account. FSA accounts through your employer may be negotiated by your employer for membership coverage.
Contact your insurance carrier directly to find out if your membership fees are reimbursable. Our office will provide a receipt if requested.
How can I reach my physician?
Members of Partner In Health AZ can reach Dr. T. at any time via telephone call, direct email to the doctor or by sending a message through a secured patient portal in the Patient Ally electronic medical record. Non-members will be asked to make an appointment.
What is your cancellation policy?
Membership at Partner In Health AZ is designed and intended to be continuous, however you may cancel your membership at anytime. If you choose to cancel, you will have to wait 6 months to reinstate your membership, AND pay a $200 reinstatement fee.
You are required to request the termination in writing, no later than the 15th day of the month, so as to provide a 2-week notice. Partner In Health AZ does not offer prorated refunds for partial months.
What happens if I miss a membership payment?
Members who miss payment for more than two (2) consecutive months will be automatically terminated, will have to wait 6 months to reinstate their membership(s) AND pay a $200 reinstatement fee. Please be advised that services, care and prescription refill requests will not be rendered if payment is not received.
How is payment for services processed?
All payments for your one-time, non-refundable enrollment fee, monthly membership fees (paid in full or in 2 installments on January 1st, and July 1st), and single payments for medical procedures are processed at time of visit or via the patient portal. Your credit or debit information is not stored by Partner In Health AZ. Please be advised that services, care and prescription refill requests will not be rendered if payment is not received.
How are medication refills handled?
Medication refills are only completed at the time of an office visit. You will be given enough refills to last until your next appointment. We do not accept calls/faxed requests from pharmacies or phoned/emailed requests from non-DPC members for medication refills. When you see that you have less than one month of refills remaining on your current prescription, it is time to schedule a visit to be seen in the office. If you run out of medication, pharmacists will often provide a 3 day emergency supply to allow you time to be seen in the office for a medication refill. If you are taking a medication deemed a controlled substance you will require an in person office visit every 90 days in order to obtain a refill as mandated by the DEA.
Will you be changing services?
Dr. T. may choose to change (add or discontinue) services or change the fee schedule. You will receive written notice at least sixty (60) days prior to any changes taking effect.
I have questions not answered here, who do I contact?
Please send an email to our DPC Transition Administrator by completing the form below with any questions that are not listed here. Please be advised that this inbox is monitored Mondays, Wednesdays and Fridays. Additionally, you may call our office at 602-237-5088 to leave a message and request a follow up call.
