Frequently Asked Questions

 

Health Insurance Questions

Do you contract with health insurance companies?  Why not?

  • I do not contract with health insurance companies so that I can spend more time with my patients.  Clinics that contract with health insurance companies deal with endless hassles and paperwork.  Because of this, their doctors spend too much time charting and less time with their patients.  In addition, they have to hire more staff to deal with all of the insurance hassles, which means overscheduling to pay for those additional staff members.

What if I have health insurance?

  • I can take patients with any type of insurance except Medicaid (AHCCCS) plans.  Most patients at Shumway Family Medicine have health coverage, such as private insurance, Medicare, or a health share.  You can still use your coverage for prescriptions and tests I order (like bloodwork or imaging).  You can also still use your insurance with specialists or at other medical facilities (like for unfortunate hospital visits or big surgeries).

What if I have Medicare?

  • No problem!  We just have to sign a document saying that neither you nor I will bill Medicare for the services provided in the office.  However, you will still be able to use Medicare for prescriptions, testing, and referrals that I provide to you.

What if I have Medicaid (AHCCCS)?

  • Due to Affordable Care Act changes, I am not able to work with patients who have Medicaid (AHCCCS) plans, as the changes now require me to be contracted with the plans in order to prescribe, order tests, and give referrals for those patients.

Should I have some form of health insurance or health share?

  • This is a personal decision, but I recommend having some form of coverage, at least to help you in the unfortunate event that you have very expensive medical costs, such as a big surgery or a hospital stay.

What type of medical coverage should I get?

  • What type of coverage definitely depends on your individual goals and financial situation.  In most cases, employer-provided insurance is going to be the most affordable option.  If that is not available, consider a high-deductible health insurance plan or a membership with a health share company, as these work well with this model.  Specifically, health share companies like Zion Health (see link), Sedera (see link), Medishare (see link), and Christian HealthCare Ministries (see link) have excellent options that combine well with a direct primary care membership, and some may even offer discounts for being enrolled in a direct primary care clinic like mine!  I have no financial affiliation with them.

 

Direct Primary Care Questions

What is Direct Primary Care?

  • Direct Primary Care (DPC) is a new and rapidly growing model of primary care where the patient and the doctor have removed the insurance "middle man" from the picture.  Each DPC varies in details, but it usually covers all of the patient's basic primary care for a low monthly rate.  A DPC doctor usually has ~300-600 patients, whereas a primary care doctor at a traditional practice often has ~2000-3000 patients.  This all means that you get more time with a doctor who knows you better, and you can be seen more easily for urgent issues than an over-booked traditional practice.

How does this save me money?

  • Even though the low monthly fee is out-of-pocket, direct primary care lowers overall health care costs!  When you get more time and access to your doctor, you avoid expensive ER visits, skip a lot of unnecessary testing and referrals to specialists, and you’re just plain healthier!  This is why some health share companies and employers are rewarding their clients with discounts or subsidies for joining practices like mine!

Does this help me be healthier?

  • Absolutely! Direct Primary Care allows you to be more proactive about your health instead of waiting until things go bad.  More time with your doctor and easier/quicker access for urgent matters also means that we get to the bottom of issues and often avoid unnecessary testing or referrals.  A flat monthly rate also gives you peace of mind, knowing that sudden medical issues that require frequent visits will not change the same low flat monthly rate!

 

Payment Questions

How are the monthly payments made?

  • The first payment is at the day of the visit. Credit cards, debit cards, cash, or check are all fine.  For subsequent months, we simply set up an automatic payment to charge the saved credit card or debit card at the end of the month (~28th day of the month).

Can I use HSA or FSA accounts for the monthly payment?

  • To the best of my knowledge, the IRS does not consider direct primary care monthly fees to be "qualified medical expenses", so you should check with an accountant or other tax professional regarding this.  This will hopefully change with legislation in the future.  However, you are certainly safe to use these accounts to pay for medications, lab testing, imaging, or any other qualifying medical expenses outside of the monthly fee.

Is there a long-term contract?

  • No!  You can cancel at any time.  There is no risk to joining!

Is there an extra enrollment fee?

  • No extra enrollment fee!  You simply make the first monthly payment at the time of the first visit.

 

Member Benefits Questions

What is a yearly wellness visit?

  • The goal is helping you be healthy and try to prevent future medical problems.  We discuss appropriate cancer screenings and vaccinations, do a routine checkup, and focus on your well-being.

What medical problems do you cover?

  • The vast majority of common medical issues can be handled here, especially with longer visits, more urgent access, and better prevention.  Sometimes, certain issues may need the help of a specialist or a hospital visit to make sure you are getting the best care.  In those situations, I help coordinate your care with the help of the specialist.

What types of office procedures are included?

  • I perform many outpatient procedures, such as joint injections, skin biopsies, lesion removal, suturing (stitching), ear lavage, and more.  Medically necessary procedures such as these are included in the low monthly rate.

Will procedures cost extra?

  • Most procedures discussed above are included with no extra fee.  Circumcisions or cosmetic procedures such as benign mole removal may cost an extra fee, but you will always know the price ahead of time.

When can talk to the doctor?

  • Any time!  Phone and email during regular business hours are used for non-urgent issues.  I usually return voicemails and emails within few hours for these.  If something is truly urgent, patients can contact me any time, even on the weekend or at night!  I want to keep you out of the ER or urgent care if possible.

What in-office testing is included in the monthly fee?

  • We can do simple tests such as EKGs, urine dipstick tests, rapid strep tests, and pregnancy tests here in the office, and these are included.  For blood tests, I help you get very affordable pricing through local lab companies.  For imaging, I help you find affordable pricing through local imaging companies.

What medications are dispensed in-office?

  • No controlled medications are stored in the clinic.  I carry common antibiotics and some of the most common medications that my patients need.  If I don't currently carry a medication you are taking and I'm able to get it for you at a good price, I can add it to my list!

 

See the Direct Primary Care Membership Terms and Agreement for more details.  You can also feel free to call or email if you still have questions!