Frequently Asked Questions
Once I join Wise Patient Direct, can I discontinue (terminate) my membership? Yes, at any time and for any reason, by providing written notice to Wise Patient. Monthly fees will be prorated to the date Wise Patient receives your written termination. Importantly, you will not be allowed to rejoin Wise Patient Direct until one complete calendar year from the date you discontinued your membership.
Can Wise Patient discontinue (terminate) my Wise Patient Direct membership? Yes, but not solely on the basis of your health status or protected status. Per RCW 48.150.050, “…the direct practice may discontinue care for direct patients if: (a) The patient fails to pay the direct fee…; (b) the patient has performed an act that constitutes fraud; (c) the patient repeatedly fails to comply with the recommended treatment plan; (d) the patient is abusive and presents an emotional or physical danger to the staff or other patients of the direct practice; or (e) the direct practice discontinues operation as a direct practice.”
Can Wise Patient decline to accept me into their Wise Patient Direct membership practice? Yes, per RCW 48.150, a direct practice may decline to accept a patient “if the practice has reached its maximum capacity, or if the patient’s medical condition is such that the provider is unable to provide the appropriate level and type of health care services in the direct practice”.
Is Wise Patient Direct concierge medicine? Wise Patient Direct is “direct primary care,” not “concierge medicine.” In concierge medicine, your doctor charges you a concierge fee AND still bills your insurance on top of that (so despite your concierge fee you are still also on the hook for your co-pays, co-insurance, and your deductible). In direct primary care (DPC), insurance is not used. Therefore, you pay just one monthly membership fee for all your primary care delivered by Wise Patient Internal Medicine, PLLC.
Can I consider Wise Patient Direct as a substitute for health insurance? We believe you would be foolish to do so.Direct Primary Care is not a replacement for health insurance, but rather way to limit the role of health insurance to higher dollar items such as surgery, prolonged hospitalization, and expensive medications. Think of your homeowners and auto insurance policies that protect you against unlikely but costly events. Imagine the rapid inflation of your homeowner’s insurance premium you would see if you started using that coverage for routine maintenance like painting, cleaning gutters, or changing out your water heater. Imagine using your auto-insurance to cover oil changes and new tires. Many scholars have written about the administrative waste and expense that creeps in because we use our health insurance for low-dollar items.
Which insurance plans pair well with Direct Primary Care packages like Wise Patient Direct? Some people, and some businesses, decide to pair Direct Primary Care with a low premium, high deductible health insurance plan that suits their needs.
I don’t get it. If I begin to pay Wise Patient a monthly membership fee, how exactly may I save money? Participating in Wise Patient Direct may or may not save you money. Here are some ways that people have saved money using Direct Primary Care:
1.) Decreased monthly health costs. If paired with a low premium, high deductible insurance plan, the premium money you save might be much greater than the monthly membership fee for primary care. Still, you will need to envision different scenarios of out-of-pocket costs for medical care you receive from parties other than Wise Patient Internal Medicine, PLLC.
2.) Major discounts for common lab tests. Under the Wise Patient Direct model, we continue to negotiate substantial discounts from laboratories (and soon to come: imaging companies) for our Wise Patient Direct patients. As a result, some common lab fees can be multiple times lower than what the same lab would charge your insurance company (or you if they billed you directly). When we order labs for you in this way, we present you with an itemized cost at the time we draw your blood and charge the same credit card you have on file for your monthly DPC membership fee. Alternatively, some DPC patients choose to have their labs billed in the traditional way, from the laboratory to their health insurance company. We are fine doing that.
3.) Less time away from work and family. Under the Wise Patient Direct model, you can optimize the amount of care we provide you via electronic means. Fewer trips to the clinic means less time away from work and family.
4.) Fewer surprise bills from insurance companies. With Wise Patient Direct, you know up-front how much you are paying for primary care. No more guessing whether the office visit will be billed at a level 3, 4, or 5, if an appointment for a given topic will or won’t be covered under your insurance plan, or what your out-of-pocket cost will be for an office procedure such as an EKG, spirometry, or punch biopsy. Not knowing what something costs before you buy it (or sell it, in our case) is frustrating. Yet that is how insurance mediated primary care currently works!
Does the WA State Legislature view Direct Primary Care favorably? Yes. Within the introduction to RCW 48.150 is found the following: “Direct patient-provider practices, in which patients enter into a direct relationship with medical practitioners and pay a fixed amount directly to the health care provider for primary care services, represent an innovative, affordable option which could improve access to medical care, reduce the number of people who now lack such access, and cut down on emergency room use for primary care purposes, thereby freeing up emergency room facilities to treat true emergencies.”
Does my DPC membership fee count against my deductible? Not for now, because subscription membership primary care did not exist when the IRS created their list of recognized medical expenses. Currently, there are separate bills in both U.S. House and U.S. Senate that would allow DPC membership fees to be recognized a medical expense by the IRS. The DPC community is optimistic one of these will pass. This would allow, amoung other things, a person to use an HSA account to pay their monthly DPC membership fee. Stay tuned.
Can I use my HSA, HRA, or FSA account to pay my monthly membership fee to Wise Patient Direct? Unfortunately not (to my knowledge). See above.
Does Wise Patient Direct work with Medicare? Not well, actually. Because Medicare is a federal program, the rules surrounding direct primary care are different than those supported by Washington State. Specifically, our Medicare contract has a clause that says it is against the contract for our practice to NOT bill Medicare for services that are covered by Medicare. The spirit if that clause, we suppose, is that practices don’t unfairly provide discounted care to some Medicare enrollees and not to others. At any rate, if you are covered by Medicare and want to joint Wise Patient Direct, we have no choice but to structure it like ‘concierge’ medicine as follows: 1) We still bill Medicare for your visits. 2) In addition, you pay to Wise Patient a concierge fee of $50/month, which is one-half of the DPC subscription rate for other-than-Medicare patients. 3) Therefore, you will still pay typical out-of-pocket costs associated with Medicare, such as co-pays and co-insurance, in addition to your monthly concierge fee paid to Wise Patient. 4) The Wise Patient Direct agreement you sign will simply state your agreement to pay the monthly concierge fee in exchange for guaranteed same-or-next business day appointments (since that guarantee falls clearly outside of Medicare’s covered services).
Please feel free to contact either of us with any additional questions.
Sam Warren, MD, MSc and Rachel Beda, MD
Co-owners, Wise Patient Internal Medicine, PLLC