Frequently Asked Questions
What s DPC?
DPC is an innovative primary care model of medicine that puts the patient-physician relationship first. We offer a full range of primary care services for a monthly or annual retainer fee paid directly to the practice.
By eliminating third party payment and the interference that comes along with it, individuals can connect more honestly - more directly with their doctor. Companies can also make this available to their employees. We handle all urgent issues immediately, and make office visits readily available.
Direct Primary Care is a fast-growing way for individuals and their families to get high-quality healthcare that is transparent, affordable, predictable monthly price.
How is DPC different from traditional primary care?
In a traditional primary care practice, doctors are paid according to specific codes they apply to patient encounters as well as the number of appointments they schedule each day. As a result, these doctors are incentivised to see many more patients in a short amount of time. It’s more of a “factory model” than one based on quality of care. By limiting the number of patient memberships in a practice, DPC doctors are more accessible, can spend more time with each patient, and get to know them personally.
Do I need insurance?
We do not bill insurance. SetMD Care will charge a flat monthly or annual fee that will cover all comprehensive primary care services. Members should still retain an insurance policy in the event of catastrophic illness or hospitalization.
We recommend a high deductible insurance plan with a lower monthly premium. To reduce your spending, we negotiate discounted prices for labs and imaging (i.e. x ray, MRI, etc). We also help you get discounted rates at the pharmacy.
Will my insurance still work elsewhere?
Your insurance plans will continue to cover your visits at other doctors’ offices, hospitals and pharmacies. Note: Some HMO plans do require an “in-network” primary care doctor for access to other services, so these plans do not pair as well with DPC membership. Please check with your insurance company.
What is included in my membership?
An annual physical exam at 225 Lewis Wharf, in Boston. Includes screening bloodwork and testing as recommended in the US Prevention Services Task force (such as cholesterol, liver/kidney function, blood counts, PSA, colonoscopy, mammogram, pap, screening ultrasound/CT for aortic aneurysm, etc) . Also risk calculation per the American College of Cardiology.
Up to 12 sick visits (in the office, or through virtual care) throughout the year
Same-day or next-day appointments
Unlimited access to Dr Paul via cell phone, secure messaging and e-mail.
What if I need a specialist?
Whenever a specialist is required, there are several ways to connect you. Dr Paul will personally contact the specialist’s office in the Mass General Brigham (MGB) health system (one of the nation’s best). (Because he worked at Massachusetts General Hospital for more than 15 years, he personally knows many specialists there.) Soon, we will also have the ability to facilitate expedited Virtual Care visits with specialists located all across the country.
What about Medicare patients?
We offer memberships to patients that are on Medicare, but we do not bill Medicare. Medicare will still cover any laboratory testing, imaging, medications, referrals to specialists, and hospitalizations.
Are there additional benefits for Employers?
Discounted rates on memberships (5 or more individuals)
On-site group flu vaccination clinics
White-labeled web app with useful health & wellness content for your employees