Frequently Asked Questions
What is direct care?
Direct care is a direct contract between patient and physician, whereby patients pay a monthly or annual fee directly to their doctor. The doctor does not bill insurance for visits and in return patients get better access to their physician, longer appointments, and no per-visit fees.
Isn't this just concierge medicine?
Not quite. Traditional concierge practices often charge a membership fee or retainer in addition to billing your insurance. Direct care skips billing insurance entirely and only charges a membership fee. That's what keeps pricing transparent and administrative overhead low.
Isn't this only for the wealthy?
Direct care is often more affordable than people expect, especially when you account for the value of prompt access, extended visits, and included services. It's also fair to consider that one comprehensive direct care visit can often cover what traditional insurance-based care spreads across several separate, redundant appointments — each with its own copay, frustration and time away from work or family.
Do I need to keep my insurance?
Yes. Direct care is not a replacement for insurance, it's a different way of paying for the visit itself. You still need coverage for hospitalization, emergency room visits, surgery, and other major medical events. Most direct care patients pair their membership with a high-deductible or catastrophic insurance plan for exactly this reason.
Can my physician still order labs, imaging, or prescriptions through my insurance?
Yes. Your physician can still order labs, imaging, and other testing through your insurance, and still write prescriptions that your insurance covers, just as they would in a traditional practice. Direct care changes how the visit itself is paid for, it doesn't cut you off from the rest of your coverage.
Are Direct Care Physicians trained differently?
No. Your physician is still a fully licensed physician in New York State, held to the same standards, board certifications, and hospital or specialist privileges as any insurance-based provider. What's different isn't their training or credentials, it's that their clinical decisions are guided by their professional judgment, not by what an insurance company will approve or pay for.
Can I use HSA or FSA funds to pay for direct care?
Often, yes. Many direct care fees are eligible for payment through an HSA or FSA. Eligibility can vary, so it's worth checking with your plan administrator or your physician's office.
Is direct care legal and is it regulated?
Yes. Direct care is a recognized model of practice, and part of our Alliance's mission is advocating for clear, sensible policy in New York State that protects both physicians and patients as this model grows.
Contact
Questions or thoughts?
Reach out to the New York State Direct Care Physicians Alliance team.
Phone
NYSdirectcare@gmail.com
518-555-1234
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