Priority Medical Partners Direct, SC -  Frequently Asked Questions
 

Definitions

Direct Pay - patients pay their doctor directly for services.  No third party billing.  Direct Primary Care Membership and Pay-Per-Visit options fall under direct pay because their is no middleman...only a direct contractual relationship between the patient and their doctor.
Third Party Billing - physician bills patients insurance (a third party) to receive payment for the services provided to the patient.
Direct Primary Care (DPC) Membership -  Patients receive comprehensive primary care services from their physician in return for a fixed, recurring monthly fee paid directly to their physician.  No insurance involvement.
Direct Pay-Per-Visit (PPV) - patients pay their doctor directly for services at time of service when they receive those services.  No insurance involvement.

What is Direct Primary Care (DPC) Membership and how can it benefit me?

Simply speaking, DPC closely resembles the doctor-patient relationship of years ago where patients received personalized care in an unhurried environment.  In this model patients receive comprehensive primary care services from their physician in return for a fixed, recurring monthly fee paid directly to their physician.  DPC occurs outside the insurance and government systems which allows for less paperwork and regulation, lower costs, and more direct time to be spent on the patient-doctor relationship.

Jay Kempton, Third Party Administrator and co-founder of the Free Market Medical Association, describes the benefits of Direct Primary Care.

 

Can you explain the similarities and differences between DPC Membership option and the Pay-Per-Visit option?

DPC Membership (which occurs outside the insurance system) provides all the primary care services we offer in our practice for one low bundled price.  Free office visits, free procedures, free advice outside of office visit, virtual office visits, same/next day face to face appointment availability, guaranteed 30 minute appointments, and our absolute lowest price ("BEST price") on lab and pathology services.   This is our most patient-centric plan.  Please visit our DPC Membership Option to learn more about the additional benefits of DPC membership.

Pay-Per-Visit option is where patients pay our practice directly (outside of the insurance system) at the time of service for the services we provide.  There is no monthly fee.  Visits and procedures come with a price tag but are significantly discounted and typically much less than what would be charged in an insurance based practice.   Pay-Per-Visit lab fees are significantly discounted as well but they are higher than our DPC Membership BEST price.  Since the Pay-Per-Visit option operates outside of insurance, patients with any commercial insurance (in or out of network) can be seen at our practice and there is NO COPAY which provides additional savings.  Please visit our Pay-Per-Visit Option section to learn more about the additional benefits of the Pay-Per-Visit option.

How does DPC Membership work?

Direct primary care practices serve as a patient's "primary care medical home" where they go for routine primary, preventive and chronic care management. Patients pay one low monthly fee directly to their direct primary care facility and in return receive primary, preventative and chronic care services.  There is no insurance involvement in DPC which reduces paperwork and visit complexity which allows your physician to spend more time with you delivering personalized care and less time performing third party administrative duties.  DPC is NOT insurance.  Unexpected emergent and serious medical conditions still do happen and typical patients in a direct primary care practice keep an insurance plan or Health Care Sharing Ministry to cover emergencies and serious illnesses. We encourage all DPC patient to have appropriate catastrophic coverage to provide coverage for emergent conditions that warrant care outside of the primary care services provided at PMPdirect.

Your Direct Primary Care membership option seems too good to be true, what is the catch?

Too good to be true - No.  It is true, and there is no catch. 

Imagine having same day face to face access to your doctor for urgent or serious illness concerns.  For minor illness, imagine being treated from your home or while you are on vacation via a virtual visit.  Imagine healthcare with no red tape, no complicated codes, no pre-authorizations or denials. 100% price transparency. A simple system where more than 80% of your needs are cared for with an affordable monthly membership fee. No hassle, no wait for appointments, and unrushed visits.  A system which promotes the doctor-patient relationship by minimizing unnecessary paperwork allowing more time for your doctor to be your doctor. A “patient-centric” system that prioritizes the doctor-patient relationship, the way medicine “was” and is meant to be.

We feel that once an individual experiences what DPC has to offer they will want to continue with their membership.  For those that don't, there is no long term commitment.  A 24 hour written notice from the patient is all that is needed to leave our DPC practice.  Please read our DPC Agreement for more information.

How can I register for Direct Primary care membership?

Please read our DPC Agreement then:
Click HERE to be redirected to our registration page, then:

  1. Please fill out:  First and Last Name, DOB, Gender, E-mail, phone, address, and provider.
  2. Click “Add Adult” or “Add Child” to add any other family members to your account.
  3. Please enter payment information (bank account for direct bank draft is preferred).  Select your bank.
    If your bank is listed, simply enter routing and account numbers.  Back account verification will be automatic. If your bank is not listed, choose “other” and enter in routing and account numbers.  In a few days’ time, please check your bank account for two small test deposits and either call our office with the test charge amounts to complete account verification process or check your email for directions on how to complete the verification process on your own.
  4. Click on the boxes in “Our Agreements” section.  Click on Member Contract to view the DPC Patient Care Agreement.
  5. Click “Sign Up” to complete membership sign up.

This will complete registration process and create patient accounts within our Electronic Medical Record.
Adult Members should then contact our office to schedule an appointment for an exam and so we can populate their medical history into the EMR.  Parents can provide histories for their adolescent children, if children are enrolled, at the time of parent’s appointment.

I'm an employer facing increased healthcare expenses.  Can direct primary care membership help me lower my costs?

Yes.  Please see our employer solutions page for additional information.

What is the difference between between Priority Medical Partners, SC (PMP) and Priority Medical Partners Direct, SC (PMPdirect)?

Separate medical practices using the same staff and office space.  PMP cares for all Medicare patients and any other patients who choose to pay for their healthcare using insurance.  PMPdirect cares for DPC Member patients and patients who pay us directly per visit (Pay-Per-Visit).

Why have two practices instead of just a regular insurance based practice or a stand-alone DPC practice?

Simply put, to meet the needs of our patients.  Our healthcare system is changing.  Many patients can either afford to purchase their own insurance plans or are provided insurance coverage by their employers while other patients and employers are facing steep hikes in insurance plan premiums and deductibles and some may even lose their insurance.  We want to be able to serve patients who choose the insurance method of payment as well as those who may not have insurance or who have insurance but who wish to minimize "out-of-pocket" costs using the DPC membership and Pay-Per-Visit model.

As a direct Primary Care Member, do I still need health insurance?

We recommend you continue to have health insurance or other suitable coverage (e.g. Health Care Sharing Ministry) to cover health care costs beyond the services of our practice such as specialist care, hospitalization, radiology imaging, and any services not provided in our practice.  Remember, DPC is NOT insurance but rather a model where patients pay a reasonable monthly fee in return for comprehensive primary care services provided by their primary care physician.  The most cost-effective coverage options to pair with direct primary care would be a qualified high deductible plan or a Health Care Sharing Ministry

I would like to be a direct pay patient but my insurance company says that Drs. Kim and Brian Erdmann are out of network? Can I still be a direct primary care member or a pay-per-visit patient?

Of course.  Remember that it matters not whether a patients insurance is considered in or out of network when a patient chooses to become a DPC member or a Pay-Per-Visit patient because our patients receive primary care services from us outside of the insurance system.   What matters to the out of network insured patient is that they have appropriate insurance coverage for services that occur outside the walls of our practice. Our physicians will work with out of network patients to ensure that referrals for services outside our practice are being made to entities in network for those patients.

I am a Medicare patient.  Can I become a member of PMPdirect?

No.  Not yet.  Drs. Kim and Brian Erdmann would be required to "opt out" of Medicare (meaning they would not be able to provide care through the Medicare system to any patient at any facility in the United States) in order to see patients in the DPC or Pay-Per-Visit setting.  Since Drs. Kim and Brian Erdmann, as agents of Priority Medical Partners, SC, choose to accept Medicare assignment and provide care to Medicare patients, they are not allowed to provide care to patients "outside" the Medicare system through PMPdirect.  There is current legislation (bill S. 1989) that is trying to change this.

Should I become a DPC member of PMPdirect, a Pay-Per-Visit patient of PMPdirect or just use my insurance through PMP?

That is up to you.  Vast majority of patients with moderate to high deductibles ($3,000+) do not reach their yearly deductible limit even when paying traditional insurance based rates; therefore, there can be considerable savings choosing our DPC membership or Pay-Per-Visit model of care which can minimize patient out of pocket costs.  If you would like us to provide you with advice to assist you in your decision just call our office and schedule a FREE 15 minute consultation so we can discuss your situation.  This visit will not include any medical or legal advice. 

What happens if I need to be hospitalized or need to see a specialist physician?

By providing same or next business day access, we seek to prevent or reduce hospitalizations and specialty referrals. In instances where specialty care is required, we will do our best to work with any specialist and even try to seek out those specialists who are willing to provide a "discounted pricing" for out patients who desire to pay cash in full at time of service in order to minimize out of pocket costs.  We will also be available for hospital physicians in the event they need to reach us in order to coordinate care.

If I have insurance and I am a member of PMPdirect, will my insurance work outside of your office?

Yes.  Remember, at PMPdirect all services provided by PMPdirect providers are occurring outside the insurance system.  You can use your insurance for services provided by specialists and outside entities and any such outside services will be covered based on the terms of your policy.

What services are covered with my dpc membership?  Is there a registration fee?

There is a one time registration fee of $75 for every adult member which is non-refundable.  Members are eligible for:
(1) Free office visits
(2) BEST pricing on labs and pathology fees
(3) Free office based procedures
(4) Same or next business day access to your doctor for evaluation.  Virtual (non face-to-face) visits for conditions that can be managed safely without a face to face visit.
(5) 30 minute appointments, longer if needed.
(6) Our commitment, on the behalf of our DPC patients to continue to search for and secure "discounted pricing" from value vendors (specialist referrals, radiology services, etc.) to whom we refer our patients

Please refer to our DPC Membership Option page for additional member benefit information.

Can children become members of PMPdirect?

PMPdirect will provide certain services to adolescents age 6-17.  Please refer to DPC Membership Option for additional information.

I AM a dpc member...can I contact my physician outside of office hours?

Yes.  PMPdirect asks patients to only call their physician outside of office hours if there condition or symptoms cannot wait until the next business day.  PMPdirect physicians are on call for DPC members 24 hrs a day, 365 days per year.  Physician time away from work is beneficial for physician health and we ask that member patients respect this by not calling after hours for routine, non urgent issues that can be dealt with the next business day. We anticipate that our increased access and time spent in the office with patients will offset the need for after hour call, but in the event that an urgent issue arises we will be there for you.

Does PMPdirect accept health insurance?

No.  Our model prioritizes (hence, the name Priority Medical Partners Direct, SC) the direct, personal relationship between the doctor and the patient.  This relationship is bolstered by our business model which operates outside the insurance system.  At PMPdirect you decide what is best for you.  You are in control of your healthcare.  You are contracting directly with your doctor for your healthcare.  Furthermore, this direct patient-doctor arrangement frees us from the typical contractual agreements that often prevents us from offering discounted prices on laboratory tests and procedures.

*Disclaimer - understand that DPC is a new and evolving model for healthcare and that the information provided on this webpage (and website) is being provided to you as a courtesy.  This information is not intended to convey or constitute legal advice and is not a substitute for obtaining legal advice from a qualified attorney.