Direct Specialty Care Frequently Asked Questions

The current American healthcare insurance system has created challenges in adequately compensating physicians for the care they provide. As a result, we are faced with the difficult reality of needing to increase the number of patients we see in order to sustain our practice in this model. While we are dedicated to delivering the best possible care to each and every one of our patients, this growing pressure to see a higher volume of patients hinders our ability to provide the level of care that you expect and deserve.  We feel hybrid direct care will allow our patients to continue to receive the high level of care we have always provided. 

In our hybrid direct specialty care model, we will only accept traditional Medicare and most Medicare supplement plans. 

We do not participate in commercial, Medicare Advantage, or Medicaid insurance plans. We have a simple, transparent fee schedule that can be found on the "Services and Pricing" page. 

The biggest benefit of a direct pay practice is a more personalized approach to your care. This practice model is aimed to increase access to your doctor when you need them and to eliminate barriers to quality care. At the same time, it allows for reasonable pricing and no surprise bills. 

If your insurance plan mandates high specialist co-pays, high deductibles, or restrictions on where you can seek care, the direct pay route is almost always more convenient and has significantly lower cumulative out-of-pocket expenses than utilizing your insurance. 

Concierge specialty care and direct specialty care share some similarities but have distinct differences:

• Concierge Specialty Care: In this model, patients pay an annual or monthly fee to a specialist, granting them enhanced access, shorter wait times, and more personalized care within that specialty. It often complements traditional insurance.
• Direct Specialty Care: Direct specialty care typically operates on a fee-for-service basis, where patients pay for each specialty visit or procedure directly. It may not involve ongoing retainer fees and often focuses solely on specialist consultations and treatments.

Every insurance plan is different. We encourage you to reach out to your insurance carrier to see whether you qualify for out of network benefits and for information about the allowable reimbursement amount as outlined by your plan. We can provide a superbill for you to submit to  your insurance company, but we cannot guarantee that you will receive reimbursement.*

We have partnered with Reimbursify to help streamline the out-of-network claims submission process. Using their system will allow our patients to submit their claims via the Reimbursify app or we can submit them on your behalf if you prefer. You can use the links at the bottom of the page to check your out-of-network benefits and to submit your claims as well. 

* Amount reimbursed might not be same as what you paid in the office. Payment is based on your out of network benefits and the amount allowed for physician services by your plan. Please check with your insurance directly.

A deposit of $50 is due at the time you schedule a new patient consultation (unless you have traditional Medicare). This deposit will be applied to the cost of the consultation on the day of your visit. We require 48 hours' notice for cancellation of a new patient consultation. In the event that a new patient consultation is cancelled less than 48 hours before the appointment or you are a no show, this deposit will serve as the late cancellation/no show fee.

We accept the following forms of payment: 

- Cash

- Personal Check

- Credit cards including VISA, Mastercard, Discover, and American Express

- Health Saving Account Funds

- Flexible Spending Account Funds