About Carolina Family Healthcare Direct Primary Care (CFHDPC)
CFHDPC is a membership- based primary care practice 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 or they have a high deductible ($5,000 or more per individual). Participants with insurance that CFH participates with who have a high deductible will need to sign a request that we not bill their insurance for services rendered.
What is Direct Primary Care?
Direct primary care (DPC) is a recognized payment model for primary care practices. Patients enroll as “participants” of the practice by paying an annual or monthly fee – also known in the industry as a “retainer”. This fee will cover the cost of an annual preventive visit and then gives the participant access to a significantly discounted fee for office visits and treatment of acute and/or chronic illnesses.
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.
Participation Fees are as follows:
Family members are defined as parents and their children aged 24 and under. All family members must have the same permanent address. Children older than 24 must have their own plan. Participation plans will start on the first day of the month that a participant joins, and will automatically renew at annual intervals until a termination request is received.
Annual participation provides a significant savings compared to monthly participation fees. When multiplied out, the first monthly participant will pay $564 annually ($47 X 12), $540 annually for the second participant ($45 X12), $516 annually for the third participant (($43 X12), $492 for the fourth participant ($41 X12), and so on. Therefore, annual participation is encouraged.
Annual payments for participation fees will be charged on the day the contract is signed, then automatically on the first day of that month for each subsequent year. Annual fees may be paid by cash, check or credit card. Because the participation fees include the annual preventive exam, HSA cards may be used for participation fee payments, however you should always check with your HSA prior to putting the card on file.
To be eligible for monthly payments, a valid credit card must be on file to be billed on the first of each month. Monthly fees will be charged first on the day the contract is signed, then automatically on the first day of the month for each month afterwards until the contract is terminated in writing. For DPC participants paying monthly, the annual anniversary date will be each year on the first day of the month that the participant became active.
Annual preventive exams are required for all participants two years of age and older. If a participant does not have a preventive exam during the annual contract term, CFH may terminate the contract and discharge the participant.
Any fees not paid on the first day of the year or month will be considered a termination of the participation agreement. If a plan is terminated, there will be a $150 per person fee to re-enroll which will be assessed during the first 365 days after participation termination (if a year or more has passed since termination, no re-enrollment fee will be assessed).
If participation fees need to be refunded, if the patient has had a preventive exam during the annual term of participation, $122 will be deducted for the preventive exam prior to the proration of unused participation fees.
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 preventive exams, or well child visits, as well as blood pressure and other screenings, and lifestyle and health risk reduction coaching.
Our objectives for wellness visits are:
- The observation of growth and development in children;
- Early detection of illness through screening examination tests;
- Immunization maintenance;
- Counseling and education;
- Getting to know one another.
Preventive care exams are included in the annual participation fee and may include the following based on age-appropriate guidelines.
- Annual preventive exams
- Well child care and developmental evaluations
- Wellness planning
- Vision and baseline hearing screenings
- Immunizations counseling
- Depression screening
- General health panel (complete blood count, complete metabolic panel, and thyroid stimulating hormone), lipid profile and urinalysis, and PSA for men.
The cost of your preventive exam is included in your participation fee, however, additional services during your preventive exam may be charged and can include:
- New Patient exam during a well adult visit $ 35
- New Patient exam during a well child visit $ 35
- Gynecological examination $ 55
- Chronic Care Management Visit $ 55
- Electrocardiograms $ 35
- Additional lab work (recommended by your provider) Based on cost
New Patient Visit
If you are new to Carolina Family Healthcare and are enrolling in CFHDPC, you will be charged $119 for your new patient visit if you are being seen for a new or existing problem.
If you are a new patient and having your preventive exam performed as your new patient visit, you will be charged $35 for establishing care.
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:
- Pre-authorizations for prescriptions, diagnostic testing and referrals to specialists;
- Prescription management;
- Review of lab work including any specialty labs;
- Consulting with specialists;
- 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 participation.
Examples of covered chronic conditions include:
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:
- 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:
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 participation fees include:
CFHDPC can provide more extensive diagnostic testing at reasonable fees to participants. These diagnostic tests include:
- Rapid COVID-19 Test $ 25
- COVID-19 PCR Swab $125
- Urine Drug Screen (in-office) $ 25
- TB Test with Interpretation $ 25
- Electrocardiogram $ 35
- Allergy Skin Testing $125 per panel
- Home Sleep Study $150
- In Lab Sleep Study $550
- Immunotherapy $ 15 per visit
- School physicals $ 29
- Mammogram $200
- Bone Density $ 55
- Diabetic Eye Exam $ 65
- Echocardiogram $250
- 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. Immunization pricing as of 1/1/2023 is as follows:
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.
All labs are drawn and performed by LabCorp. For CFHDPC participants, you will pay Carolina Family Healthcare a special price based on actual cost. Pricing for lab testing will be provided prior to any testing being performed.