Direct Primary Care
Patient Services Guide 2017
1. About Carolina Family Healthcare Direct Primary Care (CFHDPC)
CFHDPC is a membership‐ based primary care practice. This is an increasingly common model, designed to provide our patients with a cost‐effective way to pay for care if we are not participating with the patient’s insurance company. Our services have not changed – we still provide high quality, comprehensive primary care services, including treatment of acute health issues like colds or flu and chronic conditions like hypertension and diabetes. We continue to promote general health and wellness through routine wellness visits. CFHDPC also treats minor urgent care issues such as sprains, cuts and other conditions that do not require specialized or hospital care.
What is Direct Primary Care?
Direct primary care (DPC) is a recognized payment model for primary care practices. Patients enroll as “members” of the practice by paying an annual or monthly fee – also known in the industry as a “retainer”. This fee helps pay for care that will be received throughout the year, in addition to the applicable visit fee and any ancillary services charges. CFHDPC will continue to charge the patient for office visits; however these fees are significantly discounted from the standard fee schedule.
Direct Primary Care is NOT Concierge Medicine
DPC is different from concierge medicine. In concierge medicine, patients pay a premium for extra services not typically reimbursed by insurance. We are not changing the services we provide, but rather implementing a new payment model.
2. Scheduling Your Visit
Having a primary care provider you trust is important since you will work together as partners in your healthcare. Our ultimate goal is to achieve and maintain physical and emotional well‐being for patients under our care. Wellness visits, follow‐up visits, and urgent care visits are an important part of comprehensive care. Your provider will get to know you during the annual wellness visit. As a result, we can identify and manage health issues more efficiently and effectively. We encourage you to schedule your wellness visits several months in advance. For ongoing continuity of care, your provider may recommend monthly, quarterly, or bi‐annual follow‐up visits to monitor your condition(s). We suggest you schedule your follow‐up visits while in the office during the checkout process. CFHDPC typically offers same day appointment availability for urgent care related conditions. It is recommended that you contact the office prior to 3 pm to be seen on the same day. Your appointment is reserved specifically for you. Although we cannot guarantee that you won’t have to wait during your appointment because of other patient emergencies, we will do our best to stay on time and complete your visit as quickly as possible. If you need to cancel or reschedule your appointment, please notify us as far in advance as possible. There will be a $50 charge for appointments cancelled with less than 24 hour notice.
Please bring with you to all appointments: all medications and supplements you are taking, a list of other providers that may be involved in your care, a copy of your child’s immunization record (if your child is the patient), any updates to your medical history, and any forms that need completed.
3. After Hours Access
If you have a life threatening emergency, call 911. If you have an urgent medical issue, CFHDPC is available for telephonic consultations both after hours and on weekends. If you need to speak with a medical provider after hours, you can reach the CFHDPC on‐call provider by calling 704‐847‐4000 and selecting option 8.
4. Membership Fees
The maximum membership fee for families will be for five members ($780 annual fee or $92 monthly). Additional charges will be incurred based on the services rendered in section 5. Membership fees will automatically be billed annually or monthly to your credit card on file the first day of the year or month. Annual fees may be paid by cash, check or credit card. To be eligible for monthly payments, a valid credit card must be on file to be billed on the first of each month. Any fees not paid on the first day of the year or month will be considered a termination of the membership agreement. If a plan is terminated, there will be a $150 fee to re‐enroll.
5. Services and Benefits
Working with you, your provider will evaluate your current health and make age appropriate recommendations for maintaining or improving your well‐being. Visits may include annual wellness exams, women’s health, or well child visits, as well as blood pressure and other screenings, immunizations, and lifestyle and health risk reduction coaching.
Preventive care exams are seldom performed at the same time as chronic care or urgent care visits. Our objectives for wellness visits are:
1. The observation of growth and development in children;
2. Early detection of illness through screening examination tests;
3. Immunization maintenance;
4. Counseling and education;
5. Getting to know one another.
Preventive care exams are $ 99 and may include the following based on age appropriate guidelines:
- Annual preventive exams
- Pre‐conception health and peri‐ and post‐menopause care
- Well child care and developmental evaluations
- Wellness planning
- Vision and baseline hearing screenings
- Immunizations counseling
- Depression screening
- Weight management including nutritional analysis, nutritional counseling, and eating plans (available based on lab results for specific conditions)
- Glucose testing, lipid profile, and urinalysis
Additional services during your preventive exam may include:
- New Patient – Well adult $ 55
- New Patient – Well Child $ 35
- Gynecological examination $ 55
- Chronic Care Management Visit $ 55
- Electrocardiograms $ 35
- Executive Profile lab work (recommended by your provider):
- Women and men under age 40 $ 99
- Men age 40+ $129
Chronic Care Management
If you suffer from a chronic medical condition, your provider is prepared and available to help you manage your condition and guide you in making the best health care decisions. Chronic care management includes office visits for follow‐up and the coordination of your care when you are not in the office. Non‐face‐to‐face coordination of care includes:
1. Pre‐authorizations for prescriptions, diagnostic testing and referrals to specialists;
2. Prescription management;
3. Review of lab work including any specialty labs;
4. Consulting with specialists;
5. Coordination with home care companies or home equipment companies;
- Office Visits for Chronic Care (not performed on same day as preventive care visits) are $75.
- Non‐face‐to‐face chronic care management is included in membership.
Examples of covered chronic conditions include:
- Attention Deficit Disorder (ADD)
- Anxiety and/or Depression
- Heart disease including blood pressure
- Arthritis and cholesterol issues
- Chronic Obstructive Pulmonary Disease
- Pain management
- Thyroid issues
- Any other illness that needs multiple treatments
CFHDPC strives to provide same day care for your urgent medical problems. Urgent care involves those situations requiring prompt medical attention, but that are not serious or life threatening. Office visit charges for urgent care services are $55 for most visits and may include reasons for same day appointments such as:
- Flu, colds and coughs
- Sprains and strains
- Kidney and bladder infections
- Asthma, bronchitis, pneumonia, sore throats, fevers, and strep tests
- Back pain
- Wound care including contusions, suture removal, blisters, hematomas and minor burns
- Nebulizer breathing treatments
- Abscess drainage and foreign body removal
An additional charge of $40 may be incurred for more complex and extensive appointments (total appointment cost is $95). These additional charges will be assessed during the checkout process and may include:
- Removal of moles, lesions, cysts and skin tags
- Skin biopsies
- Joint injections
- Trigger point injections
- Antibiotic, steroid or other injections
Labs and Diagnostic Testing
CFHDPC is equipped to provide an extensive complement of diagnostic and laboratory work through both in house and outside referral labs. Labs included in membership fees include:
- In‐house rapid strep
- Pregnancy Tests
CFHDPC can provide more extensive diagnostic testing at reasonable fees to members. These diagnostic tests include:
- Flu Test $ 25
- Urine Drug Screen (in‐office) $ 25
- TB Test with Interpretation $ 25
- Electrocardiogram $ 35
- Allergy Skin Testing $125 per panel
- Cardio‐pulmonary Stress Test $300
- Home Sleep Study $150
- In Lab Sleep Study $550
- Immunotherapy $ 12 per visit
- School physicals $ 29
- Ultrasounds – Pricing will vary based on study performed
All immunizations are charged at actual cost and the prices included below are subject to change based on manufacturer and availability. There is no charge for immunization administration and counseling when performed during a preventive visit. During any other office visit, if immunization counseling is requested, there will be an additional $35 charge.
Age Group Price
- Influenza (flu) All $ 35
- Pneumococcal – Prevnar 13 All $194
- Diptheria, Tetanus, Pertussis (DTaP) Pediatrics $ 25
- DTaP, Polio, Hib (Pentacel) Pediatrics $ 72
- Haemophilus influenza type b (Hib) Pediatrics $ 15
- Hepatitis A Pediatrics $ 36
- Hepatitis B Pediatrics $ 15
- Measles, Mumps, Rubella (MMR) Pediatrics $ 77
- Polio Pediatrics $ 27
- Varicella zoster for chickenpox Pediatrics $132
- Human Papillomavirus (HPV) Ages 11‐18 $233
- Meningitis Ages 11‐55 $129
- Tetanus, Diphtheria, Pertussis (TDaP) Ages 11+ $ 35
- Hepatitis A & Hepatitis B combination Adults $103
- Varicella zoster for shingles Adults $221
- Pneumococcal – Pneumovax 23 Adults $100
- Meningitis B ‐ TRUMENBA Ages 10‐25 $140
Delayed Immunization Schedules
CFHDPC follows the recommended vaccination schedules as determined by the Centers for Disease Control (CDC) for children. If you are following the CDC guidelines, immunizations are given during the periodic preventive exams. CFHDPC remains a vaccine friendly practice and wants to continue counseling you with vaccine decisions as well as support you if you choose a delayed immunization schedule. If you choose to follow delayed immunization schedules, a charge of $35 will be assessed for each immunization appointment separate from the periodic preventive visits. This charge will be assessed per child, up to two children per appointment. Therefore, if you schedule one appointment for more than one child, the cost per appointment will be $70. This charge is not billable to your insurance and payment is expected at the time services are rendered.
Time‐Based Office Visits
If you have a chronic condition that you and your provider are managing together, but you feel you need more time with your provider than the standard appointment time, you may need to schedule a time‐based office visit. These visits must be scheduled in advance, and a standard appointment cannot be converted to a time‐ based office visit while you are in the office. These visits may only partially be reimbursed to you by your insurance. Fees for time based appointments are as follows:
- 30 minute appointment, all providers $150
- 45 minute appointment, excluding Dr. Kanelos $225
- 60 minute appointment, excluding Dr. Kanelos $300
If you need CFHDPC to administer injections of substances that you provide, such as hormones, birth control or vitamins, $35 will be charged for the appointment.
Hospital and Specialist Cooperation
Should you require more specialized care, CFHDPC will make the necessary referral, perform pre‐operative exams as required, and work with you and your specialist to manage your care. If you have insurance to cover the specialized care, CFHDPC will strive to make the referral to an in‐network specialist. Should you require hospitalization, CFHDPC will work with a hospitalist to coordinate and manage your care.