Frequently Asked Questions

Quick answer: No, a direct primary care practice does not accept or bill ANY insurance of any kind, including Medicare.  That being said, you can still use your insurance for services outside of Reed DPC.

For instance, Dr. Reed can absolutely order services that ARE covered by (almost) any insurer.  Although your monthly membership fee to Reed DPC is not billed to your insurance, you can still use your current insurance coverage for laboratory, imaging, specialist visits, emergency visits, hospital stays, surgeries, and prescription services.

The vast majority of private / employer and Medicare plans will cover services ordered by Dr. Reed in the same way and at the same cost as any provider on their “in-network” list.  One exception would be most “HMO” plans, which can be very restrictive in who they work with.  If you are on an HMO plan you should query your insurer directly on whether they would cover orders from Dr. Reed as a non-HMO provider.

Absolutely!  We recommend that you have at least catastrophic coverage of some kind for any emergencies.  Please also read the other frequently asked question responses about insurance for more insight.

Yes, see above discussions as well.  You absolutely should keep some form of at least catastrophic coverage for your care.  Joining Reed DPC does not in any way change your relationship with your insurance.  Your insurance will still cover lab services, xray and imaging services, referral services, hospitalizations, etc.  Dr. Reed can order these things for you, and they will be covered as in-network (if done at an in-network location).

Yes, if at all possible, you should carry at least some form of catastrophic coverage.  If you need to be hospitalized or go to the emergency room because of a major illness or injury, your membership with Reed DPC would not cover these bills that occur outside of the scope of your primary care office.

Working with Reed DPC can help to cut the costs of your overall medical care, however.  Because your primary care office can cover 85-90% or more of your healthcare needs, many people will get by with catastrophic coverage only.  A cost-sharing ministry or membership such as Samaritan Ministries, Christian Healthcare Ministries or Sedera can be another good option.

A Direct Primary Care practice works very well with a High Deductible Health Plan or a Health Sharing Membership.  We can work to minimize medication, laboratory and imaging costs dramatically compared to what is typical pricing in a health system.  With a high deductible you pay for these things until you meet that deductible, and we can help you to pay far less than you are likely used to.

Dr. Reed can order your prescription medications that would still be covered under your insurance plan in the same way as you are used to, and at the pharmacy of your choice.

No, membership fees cannot be billed to insurance.  Medicare patients in the practice must sign a waiver that they will not attempt to seek reimbursement from Medicare for their membership fees.  This would be considered an act of fraud by CMS (Centers for Medicare & Medicaid Services).

This would be a good question for your tax professional or HSA provider. Ultimately, it is your HSA provider who will determine if your expenses are reported as “qualifying” to the IRS. It is our opinion that the IRS documents on the subject (IRS Publication 502 and IRS Code Section 213(d)) are clear that these funds can be used for payments to physicians. For an expense to qualify for payment from an HSA, IRS Publication 969 defers to IRS Publication 502. In publication 502, under the heading “What Are Medical Expenses?” it relates:

“Medical expenses are the costs of diagnosis, cure, mitigation, treatment, or prevention of disease, and for the purpose of affecting any part or function of the body. These expenses include payments for legal medical services rendered by physicians, surgeons, dentists, and other medical practitioners.”

So, if you would like us to bill your HSA or FSA card for your membership, we are happy to attempt to do so. Ultimately, however, we are not tax professionals and we recommend you seek advice before doing so (preferably in talking to your HSA administrator and/or tax advisor). You may want to reference the above publications in case they are not familiar with DPC practices.

Yes, this is quite possible and even likely.  There are many ways that a DPC membership can give you great value for your money.  For starters, see the above discussion about cheaper healthcare coverage options (catastrophic only or cost-sharing ministries) that may help you save dramatically when paired with membership at Reed DPC.

Traditional insurance plans often come with a deductible that must be met before your insurance pays anything.  For the average reasonably healthy person, they will pay the cost of their insurance every paycheck and then will also pay for any visits that they have in the year because they will not meet their deductible.  If you have as many as two visits and associated lab work in a year, this will easily approach or exceed your entire year’s cost of a membership with Reed DPC.  Even one ER visit that could have been prevented with access to your primary physician would likely exceed the cost of a year’s membership with Reed DPC.

In a Direct Primary Care practice your physician knows you better, has time to get you in when something happens, and has a desire to make your care as economical as possible.  DPC practices contract with purchasing organizations to keep cost of materials down, and can often help you decrease the cost of your medications even lower than your insurance coverage.  DPC practices can also help to minimize cost of laboratory and imaging services by contracting with local providers for wholesale cost.  All of this means that you get more for every healthcare dollar you spend, and ultimately are likely (in the end) to be spending less overall as well.

Although Dr. Reed can provide much of your care, emergencies happen, and we would advise having coverage for such a circumstance. That being said, if you are entirely self-pay, we will work with local services to get you lowest-cost prices for your lab work, imaging studies and referrals. This can amount to substantial savings over what you may be used to paying historically.