What is Direct Pay?

What is Direct Pay Dermatology?

• Direct Pay care is a growing practice model for frustrated patients and frustrated doctors.
• Insurance companies and government entities have increased regulatory burdens and restrictions on the health care we can provide, all the while decreasing reimbursements to physicians and decreasing covered services for patients.
• Many doctors have responded to the problem by adding patients to their schedules just to get by. This leads to a culture of burned out doctors, unhappy patients and a decrease in quality patient care.
• Patients want unhurried, personalized, quality care and respect for their time. Direct pay medicine addresses these problems.
• You will have the time you need with your doctor to have a thorough history and exam and treatment plan, with time to discuss options and have questions answered.
• You will not have long wait times to get in to see the doctor.
• You will have straightforward pricing – visits and procedure costs will be explained to you ahead of time. There will bo no surprise bills and facility fees that insurance companies so often surprise you with after the fact.
• Direct care is NOT concierge medicine. There are no annual fees.

What Direct Pay assumes and requires:

• Our practice is predicated on mutual respect for the physician’s and the patient’s time.
• We will estimate the time needed for your visit and procedures to the best of our ability.
• We will run on time to the best of our ability.
• We respect your time, so you must respect ours for the system to work. For your initial appointment we need you to come in 15-20 minutes ahead of your appointment to complete paperwork. If you don’t, that time will eat into your appointment time, which will mean you get less accomplished at your visit for the same cost. We have to respect the time of the patient waiting to be seen after you. Consider traffic, etc., and please give yourself some extra time to get here. We have a lovely waiting room where you can relax and have a cup of coffee or tea, if you happen to arrive early.
• Appointments are longer than in typical practices, so we must ask that you cancel at least 24 hours in advance or be charged a deposit fee (which will depend on the time allotted for your appointment or the procedure scheduled).  Cancellations for Monday must be made the previous Friday morning.
• In medicine, emergencies happen – for example, a patient might schedule an appointment for a cyst evaluation, and it actually turns out to be an abscess that requires an immediate surgical procedure called an incision and drainage. That may lead to occasional wait times. The same courtesy and care will be extended to you should you happen to require more intensive, immediate care.
• We understand that emergencies happen in your own life. If you come down with Covid, for example, you will not be charged for missing your appointment. If emergencies keep coming up, and several missed or late visits occur, then we will have to determine if the practice is the right fit for you, and/or if you will have to pay for the missed or late visits (if you would like to remain part of the practice).

What is and is not covered under Direct Pay care:

• We do not contract with insurance companies, and that includes Medicaid and Medicare.
• Many insurance companies provide out-of-network benefits and will reimburse you for a significant portion of your visit.
• You must pay for your visit at the time of your visit, but we will provide you, upon request, with a detailed bill that you can submit to your insurance carrier.
• We welcome Medicare patients but Medicare does not allow you to submit bills for out-of-network physicians. They will not reimburse you.
• Medicaid will not let you be seen for medical services performed by out of network providers. We can see you for cosmetic services.
• Pathology fees, laboratory fees and prescriptions will be covered by insurance.
• If you need Mohs surgery or an extensive surgery not performed at our practice, we can refer you to providers who accept insurance
• If you need referrals to other specialties, like rheumatology or allergy and immunology, we can refer you to providers who accept insurance.