frequently asked questions

General

What is direct primary care?

Direct Primary Care is a model of health care that puts patients first by getting rid of the red tape that constrains traditional practices. It’s simple: we don't bill insurance, and instead we charge a low monthly membership fee that covers all of our patients’ primary care office visits and services. A simple, fixed price—similar to a Netflix or a gym membership. This allows patients to better budget their healthcare; without worrying about extra costs, co-pays and deductibles for routine care. A membership with Promina Health also includes deeply discounted medications and labs.

Why direct primary care?

In traditional practices, the doctor-patient interaction is driven by the need to generate billing codes and high-volume. It can be enormously expensive and frustrating for patients. Since we spend zero time chasing down insurance reimbursements and paperwork, we focus all of our time providing extraordinary care to our patients. We aim to take care of 90% of our patients’ health care needs at a much lower cost, while providing a much more satisfying experience overall.

What does my membership include?

For a flat monthly fee (see Pricing page for membership options), patients receive unlimited office visits for a full scope of services including, annual wellness exams, pediatric care, women’s care, sports physicals, school physicals, chronic care office visits, follow-up visits, procedures, and treatment of acute illness or minor injuries. Patients also have direct communication with their doctor via phone, secure text, or email.

How is this supposed to save me money?

We help patients save money in four ways: 1) the vast majority of patients’ health care needs are provided for a fixed, predictable monthly amount that they can budget for; 2)there are no co-pays or co-insurance for any office visits or routine physicals; 3) we offer direct pricing (as much as 80% savings) for labs and prescription medications, and; 4) expensive services such as urgent care or emergency room visits are avoided because patients can send questions directly to us via phone or secure text – something most traditional practices don’t offer. More importantly, since patients are getting all of this amazing care from us, many have found that they’re able to re-think and adjust their insurance plan to a high-deductible, lower premium plan to cover unpredictable, catastrophic events, like accidents or cancer.

How do I know if this is for me or my family?

Are you frustrated by the current health care system?  Do you avoid going to the doctor when you need to because you are afraid of what it will cost?  Have you ever gotten a big surprise in the mail weeks after a health care encounter?  Do you desire a strong doctor-patient relationship?  Do you feel like there are very tall barriers between you and your/your child’s doctor?  Would you like same-day/next-day appointments that start on time?  Would you like to be able to handle simple problems over email/text/telephone with your personal doctor?If you answered yes, to any of these questions, Promina Health is a great option for you!

Can I schedule an appointment without becoming a member?

No. To keep things simple and consistent for all of our patients, we do not provide visits or care outside of our standard membership system. If you’d like to visit our practice and meet your doctor prior to joining, we’d be happy to schedule a free meet and greet. Simply call our office to schedule.

Is this the same as concierge medicine?

No. Concierge medicine has traditionally described a medical practice for wealthy patients who pay an expensive premium upwards of $5,000 annually to see their doctor. Concierge doctors typically still participate in insurance, so the rules and restrictions of health insurance are still in place. Direct Primary Care offers patients concierge-level services, but the membership fees are much more affordable (at Promina Health, only $540-$888/year) and they do not participate in insurance.

Can I contact my physician after hours?

Yes! Around-the-clock access to your physician by phone, text or email is one of the greatest benefits of being a patient at Promina Health.

What are others saying about Direct Primary Care?

Insurance

What insurance do you take?

Our practice does not contract with any third party payers, meaning we will not submit any bills on your behalf. And this is actually great for both you and us! When the middlemen are removed from primary care, the doctor-patient relationship is restored, and you get far better care at a fraction of the cost.

I already have insurance, won't I be paying twice for the same services?

In many ways, patients in the current healthcare system are already paying twice with co-pays, co-insurance, deductibles, non-covered services, out-of-network charges and the list goes on…

The average family of four pays over $4,000 in out-of-pocket medical expenses over the course of a year. With Promina Health, the average family of four will pay $1,920 per year for their membership ($60 per adult per month + $20 per child per month x 12 months). This includes unlimited visits with their physician and all of our professional services. We also help patients contain their out-of-pocket expenses by providing direct pricing (as much as 80% savings) for labs and prescription medications, and offering free e-consults with specialists if needed. And, if outside services (such as an X-ray or specialist visit) are needed, their physician will be right by their side to help find the most valuable, cost-effective options.

So, we’ll let you do the math, but we find that most of our patients are better able to predict and contain their annual out-of-pocket expenses, while saving hundreds, even thousands of dollars on their health care expenses each year.

What if I am healthy and rarely go to the doctor?

YAY! (insert happy dance emoji!) Our primary focus is to keep our patients well and avoid unnecessary medical care. Our practice model allows us to dedicate more time to prevention and supporting our patients’ healthy lifestyle goals so that they can continue to avoid the expensive parts of the healthcare system. However, when our patients do need care, they have peace of mind about around-the-clock access to their doctor so that urgent care or ER visits are avoided, and little-to-no waiting during their appointment, so that they can get back to work, family or vacation as quickly as possible.With out-of-pocket deductibles close to or over $5,000 for most insurance plans, it doesn’t take much more than a trip or two to Urgent Care or the ER for the cost of a Promina Health membership to be well worth the low monthly fee.

Can I submit visit claims to my health insurance plan for reimbursement?

For the time being, insurance companies do NOT recognize our membership fees as a reimbursable expense. For non-covered service fees (meds, labs, etc.), we can provide a receipt of payment so you can process with your insurance plan if you wish. However, most of our members have not found it not worth the time and effort to do so.

I don't have insurance - can I still be a patient?

Yes, we take care of any patient regardless of your insurance status.

Is Promina Health a substitute for health insurance?

No. Promina Health is a great way to receive high-personalized primary care, but insurance is needed for unexpected and larger medical expenses.

Do I still need health insurance?

While we don’t require patients to have health insurance, we recommend coverage for the unpredictable, catastrophic events, like accidents or cancer. By focusing on keeping patients healthy, preventing diseases, and doing a great job of managing the ones they have, we hope to keep patients away from the high-cost parts of the health system. However, there's always a chance for unexpected accidents or health problems, and that's where insurance comes in.  Many of our patients find that a high deductible medical plan or a plan with a health savings account works well for our practice model. Another option many of our patients use is a Share Plan, like Liberty HealthShare orMedi-Share. We can share what’s working for some of our patients, but we also recommend that you consult with an insurance provider to help you find a plan that works best with our medical model and that will meet your specific needs.

If I have Medicare, can I still join?

Yes. However, your monthly membership fee cannot be submitted to Medicare for reimbursement.You will be asked to sign a waiver that declares that neither you nor your doctor will directly bill Medicare for your membership fee. Medicare and Medicare supplemental insurance will still cover medical costs that you incur outside of Promina Health.For example, prescriptions that you fill at an outside pharmacy, or labs run at an outside lab, or hospital charges, physical therapy, x-rays and scans can still be covered by your Medicare. You do not lose your Medicare coverage for other medical needs just because you are a patient of Promina Health.

Is the membership fee eligible for HSA or FSA reimbursement?

This is a complex question. Please contact us to discuss.  

Services

Can children become members too?

Absolutely! We care for infants, children and teens. All standard childhood health care services are included, such as newborn visits, well-child visits, acute care visits and chronic disease management (asthma, allergies, etc.).

What kind of women’s care do you provide?

We provide standard women’s and gynecologic services, including pelvic exams, pap smears, birth control, IUD insertion, and menopause management.

What about labs, imaging, and specialty services?

Our patients have access to significantly discounted labs and diagnostic testing.For example, most lab tests can be done through our practice for just a few dollars. These same tests at a hospital or and insurance-based practice would cost many times more.  The same goes for other services. (See our prices and how they compare to other practices.)We pride ourselves on care and price transparency. We will never recommend a lab or test unless we think our patients truly need it.

What happens if I need to go to the hospital?

Our physicians will coordinate a patient’s care with the hospital’s team for no extra charge. However, all other hospital charges and associated costs will still apply. That’s when your insurance will come in.

What if I need medical attention while I’m away from home?

Because you'll have access to your doctor via phone, email or text, you can reach out whenever you need, wherever you are. Some illnesses can be diagnosed and treated with a simple conversation.If you need to go to the hospital or seek other medical attention while away from home, we can advise you on that as well.

Pricing

How much is a membership?

Please see our Pricing page for membership options.

Is there an enrollment fee?

A one-time, non-refundable enrollment fee will be charged to each new billing account that is equivalent to the monthly membership fee. See Billing and Payment page for more.

Are there any income or health guidelines for becoming a patient?

No, the monthly membershipamount is the same regardless of income, insurance status, level of health or utilization of our services.

Are there any contracts or commitments? What if I decide to cancel?

We do not require patients to sign any contracts that commit them to a certain period of membership. See Billing and Payment page for more.

Are there any hidden fees?

No. The vast majority of our services are included in your monthly membership. If your doctor recommends a non-covered service,and you agree to it, the amount of the service will be shared upfront.

Visits

Can I really have UNLIMITED visits without co-pays?

Yep.

What are your regular clinic hours?

Our hours are 8:00a - 5:00pm, Monday-Friday. However, all members have around the clock access to the doctor by phone and after-hours visits if required.

Are you a walk-in clinic? Do I need an appointment?

While we offer same or next-day to our members, we do require that all visits be scheduled.

How long are doctor visits?

Since all of your visits are included in your membership, you get as little or as much time as you need! Most of our visits are scheduled for 30-60 minutes, but if more time is needed, your doctor will do their best to extend the visit, or schedule a follow-up appointment at the next convenient time for you.

FAQs- Employers

How is a Promina Health membership implemented in my business?

It depends on the size of your business. It can be offered as a standalone benefit or integrated with your current benefits.

We provide health insurance for our employees. Why do we need Promina Health?

We are not a replacement for health insurance. Insurance is needed to cover unpredictable catastrophic events. Our goal is to improve access to personalized primary care, and reduce the need for ER, urgent care, specialists and other expensive parts of the health care system. A fixed, predictable monthly amount covers 80%-90% of your employee’s health care needs all in one place, resulting in fewer healthcare claims and lower overall costs. Many employers also find that when they partner with direct primary care practices like ours, they can select a higher deductible health plan with a lower premium.

Does Promina Health pair with my business if we are self-insured?

Absolutely. Your employees’ healthcare costs are your own when you are self-insured, so Promina Health helps reduces your overall health care spend by providing highly-personalized primary care and reducing your employees’ need for more expensive healthcare services.

Will I have to change my current benefit structure?

Promina Health membership can be offered with no change to current benefit plans. However, some modifications may be needed to maximize financial impact. Our team can look at your current plan and make recommendations.

Could I offer this as a stand-alone benefit to my employees?

Yes, we currently work with small businesses who offer this as a stand-alone benefit to their employees.

Can I sign my business up anytime, or only during open-enrollment?

You can sign up at any time.  We will work with you and your insurance broker, if you have one, to find the best solution for you and your employees. Promina Health provides all employee education and seamless enrollment.

Do I need to purchase my employees a traditional health insurance plan to pair with Promina Health?

We don’t require patients to have health insurance, but we always recommend coverage for the unpredictable, catastrophic events, like accidents or cancer. By focusing on keeping patients healthy, preventing diseases, and doing a great job of managing the ones they have, we hope to keep patients away from the high-cost parts of the health system. However, there's always a chance for unexpected accidents or health problems, and that's where insurance comes in.

What if my employees need a specialist, or require hospitalization?

We deliver enhanced preventive care, significantly reducing expensive specialist visits and hospitalizations. In fact, we can cover 80-90% of health care needs. Needs outside of that would be covered by your company’s commercial insurance benefit.

What if my employees don’t want to change their doctor?

Promina Health Direct Primary Care membership is usually implemented as an option that employees can choose along with other benefit plan options. We will hold town-hall style meetings at your location for those interested to explain the concept and answer questions.

What about my employees outside of Wilmington?

Depending on their location, we can usually find Direct Primary Care partners that can deliver the same kind of highly personalized care.