Frequently Asked Questions
Do you accept my insurance?
No. That's the main feature of this practice. Using insurance for primary care makes it far more expensive than it would be otherwise.
What if I don't have insurance?
We encourage everyone to carry a catastrophic or high deductible policy to cover major expenses and illnesses. However, we don't require this as a condition for membership.
Will my insurance cover outside tests or consults that you recommend?
Usually insurances will cover tests ordered and referrals by an "out of network" physician, but that is not always the case. Patients should check with their insurer for the specifics of their policy. Be wary of HMO and Medicare Advantage policies that require you to have orders approved by an insurance oriented provider.
Can I get reimbursed by my insurance?
This varies considerably depending upon the insurer and policy. Many insurers will cover some portion of care by an out of network physician. Medicaid and Medicare do not reimburse patients for our primary care fees but will generally cover ordered tests and consults.
What if I have Medicare?
We're happy to announce that we will be fully open to Medicare patients on April 1st, 2016 (no fooling). Again, Medicare will cover tests and consults ordered. Medicare Advantage, however, is much more restrictive and requires their patients to get approval from a Medicare Advantage provider for tests and consults.
What if I have Mainecare (Medicaid)?
Mainecare patients are welcome. Mainecare will generally cover ordered tests and consults but will not reimburse patients for our primary care fees.
Why are your prices so low?
Our prices are low because we no longer incur the expenses of processing insurance payments. A typical primary care practice spends 60% of revenue on overhead, including clerical staff to bill insurers for patient appointments and treatment. Hospital run practices often run even higher overhead costs per physician with correspondingly high prices.
Since Direct Primary Care is a new concept to this area and this is a new practice offering basic primary care, we think it is important to keep our monthly fees as low as possible. Besides the lower overhead due to our direct primary care model, we've designed our practice to function effectively with fewer staff and other expenses. With that and a small scheduling fee per office visit, we're able to offer basic primary care monthly fees even below that typically charged by direct practices.
Why can't I simply pay as I go without a monthly fee?
While this was common decades ago, there are a lot of drawbacks. When a physician only gets paid for office visits, care outside of office visits, such as over the phone, is discouraged and fees per office visit are much higher. Practices in that model need a much larger patient panel and schedule more patients per day with less time per patient. Even Medicare has realized this and has instituted a monthly fee for primary care of patients with chronic problems.
Do you offer Suboxone (buprenorphine) treatment for opiate addiction?
Yes. We offer addiction treatment with buprenorphine plus counseling. Due to DEA restrictions on this and the small size of our practice, space is limited. Since this includes more frequent visits, counseling and testing, this is offered as an additional service beyond our basic membership. See our Addiction Recovery Program page for more details.