What is a PCHWellness Direct Wellness Membership?
Using the Direct Primary Care practice model as a foundation, Patient Centered Healthcare & Wellness has removed the insurance companies’ control over reimbursement for our services. This also removes the copay and co-insurance charged to the patient for each visit. This model permits the patient to pay the provider directly for their care and allows providers to decrease the patient volume in the practice. Direct Primary Care is not “concierge medicine.” We do not require patients to hold health insurance policies. We are paid directly by the patient to provide primary care services instead of billing insurance companies for reimbursement.
Unfortunately, due to the current healthcare system, MDs/NPs/PAs are forced to see anywhere from 4-6 patients in 1 hour to keep their practice open. Insurance companies have changed how providers make medical decisions and how much time they can spend with each patient during office visits. Direct Primary Care Memberships for primary care services places the control back into the patient and the provider’s hands. PCHWellness Direct Wellness Memberships will follow the latest national guidelines that are released by the United States Preventive Services Task Force (USPSTF), American Academy of Family Physicians (AAFP), etc. The timing of screenings and wellness appointments will be consistent with the most up to date practices by all advanced specialties.
I just signed up for a membership, what do I do next?
Our office will contact you within 1-2 business days to schedule your initial appointment. In the meantime, obtain your medical records for the previous 1 year with your primary care provider. If unable to obtain the entire year, please obtain the last set of diagnostic labs/imaging and most recent office visit record. Please have a list of all your current medications (prescription/over the counter) and supplements that you take daily. Please have the medication/supplement name, dosage and how many times a day. Plan to bring these to your initial visit.
Can I have Medicare and purchase a PCHWellness Direct Membership?
Yes. We accept Medicare patients. The membership services provided for Medicare patients will differ from non-Medicare patients. We will provide your complete primary care as deemed by Medicare. The membership benefits for Medicare patients include increased provider availability, patient portal access for all medical records, PCHWellness Direct seminar/education materials, increased discounts on supplements, discounts on aesthetic services and preparation of health-related paperwork.
Can I have private insurance (Aetna, Florida Blue, BCBS, Cigna, Humana, United Healthcare, etc.)?
Yes. We suggest you carry at LEAST a high deductible plan for high-cost specialist services and surgeries. We will work with your private insurance companies if prior authorizations are required for diagnostic procedures, referrals and/or medications.
Can I submit my monthly membership cost as a claim to my insurance company for reimbursement?
Will you or can I submit my office visits to my insurance company for reimbursement?
Can I use my Health Savings Account or Flexible Spending Account to pay for my membership?
Currently, we are unable to accept this form of payment for membership services. This is for your protection due to IRS regulations. You may use your HSA/FSA for non-member office visits at PCHW, supplement or procedure purchases. We highly suggest keeping your HSA/FSA for out of pocket costs for specialists/hospitalization, imaging, labs, supplements and prescription medications.
Will you be able to order special labs, procedures, referrals, imaging or testing?
Yes. We can order anything related to your care outside of the included membership services. If you have insurance, these services will be covered according to your coverage terms listed on your insurance policy.
Does my membership cover me while I am admitted to the Emergency Room or Hospital?
While you are at the emergency room and hospital, the providers on staff (MD/PA/NP) will only have privileges to direct your care. If they contact our practice for information related to your care, we will provide information with your signed medical release. This is typically a form the hospital will provide to you and they will fax your records to us. We ONLY release medical information that you authorize at that time.
If I am out of town, will I still be able to obtain medical care from the PCHWellness Direct providers?
Once a member, you can contact us via phone, email and virtual visit. If it is a minor illness that can be properly diagnosed via communications, we will be able to locate your nearest pharmacy and provide treatment as indicated.
Can I come to your practice and just pay for a visit as a self-pay patient (without buying a membership)?
Yes. If we are unable to accept your insurance, you may pay the self-pay rates on a pay per visit basis. Initial office visits are $150. Follow-up and routine visits are $75 per visit. Virtual visits are $30-60 per visit. Please be advised none of the membership benefits will apply to these visits. You will be provided with the same high-quality healthcare management and care, as all of our members. We will still provide resources for information on the best self-pay pricing for prescriptions, imaging, and labs. We highly suggest obtaining a membership for optimal services and access to the providers. Space is limited for both non-member patients and PCHWellness Direct members.
Am I required to sign a time commitment contract?
No. You may cancel at any time. Payments must be maintained monthly to keep your membership active. Non-paid memberships greater than 5 days past due date (the 1st day of each month) will be considered a canceled membership.
If I cancel my membership, may I decide to rejoin as a PCHWellness Direct member?
Yes. You must enroll and pay the initial membership processing fee of $99 to rejoin as a PCHWellness Direct member. If you rejoin at the time there is a waiting list, you will be placed on the waiting list. Patients on the waiting list are enrolled in memberships in order that they are received. There is no cost to sign up for the waiting list.
Can I purchase memberships for my small business employees?
Yes. Please contact our office to schedule a consultation regarding pricing for small business employee memberships.
Can I gift a membership?
Yes. Please contact our office to schedule an appointment for this option.