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Direct Primary Care
Frequently Asked Questions
How can this be so inexpensive?
Primary care physicians (PCPs) are known for their ability to provide comprehensive high-quality care at low cost. For decades, insurers and government agencies have relied on the tremendous cost savings PCPs provide in order to reduce the cost of care. Unfortunately, when insurers bundle the inexpensive primary care with high cost medical treatments, surgical care, hospitalization and drugs, it raises the cost of routine care for everyone and creates a barrier to access.
At Epiphany Health, we believe that everyone should be able to afford primary care. We have uncoupled primary care from those cost-driving services, and added a network of affordable services to create our membership-based primary care package. By bundling all of the routine and necessary services into a low monthly fee, our members enjoy an affordable patient-centered medical home with true price transparency.
With Epiphany Health, 100% of your expense goes towards your health care and we pass the savings on to you.
Is Epiphany Health Insurance?
No. We are physicians who contract directly with our patients to provide primary care services. Our program is membership-based with a low monthly fee, much like a gym membership or Netflix.
Does this meet the Affordable Care Act (Obamacare) insurance requirement to avoid tax penalties?
No. It is not insurance. However, the Affordable Care Act (ACA) tax penalty has been eliminated by Congress effective January 1,2019. (Consult your tax advisor). We still recommend insurance for unexpected major medical expenses.
What if I need to go to the hospital?
The Epiphany Health program does not cover hospital care. This is why we suggest you look into a high deductible health plan (HDHP) for catastrophic coverage. Should you require admission to the hospital, our physicians will be glad to coordinate that for you.
Are there any exclusions for pre-existing conditions?
No. There are no pre-existing condition exclusions and there are no increases in the membership fee based upon prior health history. In fact, those with chronic medical conditions are perfect for Epiphany Health. The only exception is that Epiphany Health physicians do not prescribe chronic pain medications or chronic controlled substances.
Who determines which health care services I can have?
Epiphany Health is a pure relationship between you and your doctor. 100% of your health care decisions are determined by you and your physician, not an insurance company. Nobody outside the exam room decides your health care, unless you allow it.
I am already paying a monthly fee for health insurance. Why do I need Epiphany Health?
In most cases, patients save money by choosing a higher deductible health plan and paying directly for medical care through Epiphany Health.
At Epiphany Health, we don’t believe insurance should be used for routine, expected medical care. You don’t use your homeowner’s insurance to pay for lawn maintenance or to make minor repairs. You don’t use your automotive insurance to fill the gas tank or replace the tires. Why would you use health insurance for a cold, to treat diabetes or high blood pressure? Health insurance should be there to cover unexpected or high ticket medical costs. We will make the routine medical care cost less than you pay for your cell phone.
Is this concierge medicine?
If providing a high quality of care is “concierge”, then maybe we are. Our practice has been referred to nationally as “concierge care for the little guy.” We provide concierge level of care at prices everyone can afford. Our practices are fine dining in a fast food world. Epiphany Health physicians provide attention to detail that is missing in most medical practices. You will always see YOUR doctor, not an assistant or surrogate. Our physician practices are independently owned and operated. That means that your doctor works for YOU, not a corporate employer. Expect same or next day appointments for urgent conditions; extended visits; direct coordination of care; messages returned and prescriptions refilled in a timely manner; office staff that knows you; and care provided in a comfortable and clean environment.
Our patients are treated as we would expect our family to be treated.
Can you show an example of the savings?
As part of the Epiphany family, you will have access to many other services, with discounts of 50-90% off of regular charges*. Our affiliated service partners include a national lab, accredited imaging facilities and board certified physicians. The prices for most service will be listed menu-style, so you'll know ahead of time approximately what services should cost. This is true price transparency. If you have a high deductible insurance plan, you can choose to pay the contracted rate or pay cash through your Epiphany plan and pocket the savings!
*Discounted prices apply only if paid at the time of service, otherwise regular charges apply.
How does price transparency help me?
A little known secret…many times, our members’ self-pay prices beat what you would pay by using your health insurance benefits. We secure complete price transparency for services from our preferred partners. Our members know exactly what they will pay for imaging, labs, physical therapy, medications and certain specialty care.
Do I Need to Sign a Contract?
Yes. In order to keep our prices low we ask for a 12 month commitment. At the end of the contract term you may cancel. After, your contract will renew month to month.
I want to see the doctor, but I’m not sure if I want to sign a contract.
We currently do not offer services on a pay-as-you-go basis, much the same as Netflix does not allow you to pay for a single movie without a membership. You are welcome to tour our office. Contact our office manager to schedule your tour. There are many urgent care centers in the region for single office visits. We are looking to develop a long-term relationship with you. Also, feel free to follow our Facebook page and get to know our doctors through their weekly live webcast.
What if I need medication?
We have an onsite dispensary for commonly prescribed antibiotics and acute illness treatments. We purchase those meds at wholesale and pass along the savings, allowing you to skip the pharmacy lines when you don't feel well. Most of our antibiotics cost between $5-$10 per prescription. For chronic medications, many are available in an acceptable generic form. Our physicians are knowledgeable on how to get you the best prices on medications. Brand name medications can be pricey, but our affiliated pharmacies will try to help you find the best prices in town.
Are Family Members Eligible for Membership?
Yes. Epiphany Health physicians see patients ages 5 and up.
How can I Enroll?
Click on the CONTACT US button and send us your information. A representative will be in contact. Or, you can call us directly at 941-423-9936 and tell the representative that you are interested in membership in Epiphany Health.
I am Currently Enrolled in Medicare, but the Epiphany Health Prices are Less Expensive than I Pay with Medicare. Can I Become an Epiphany Health Member?
We do not recommend that our Medicare patients drop their Medicare coverage in exchange for membership. Medicare patients are eligible to enroll in our membership program with our doctors. However, Medicare will not reimburse for any costs of the membership. Our physicians are opted out of Medicare, which still allows them to to order covered services outside our office for Medicare beneficiaries.
If my insurance status changes, can I cancel my membership?
You may non-renew your membership at the end of your first annual term. After that, your month-to-month membership may be cancelled with 30 days notice. There is no cancellation fee, but there is a $150 re-activation fee for patients that cancel their membership and renew at a later date.
I own a business. Can I provide Epiphany Health to my employees?
Of course! No business is too small or too large to benefit from Epiphany Health.
Although we aren’t a worker’s compensation provider, since we don’t charge for our services, we can treat minor work related problems without any difficulty, often saving a claim on your worker’s compensation policy.