Williston Pediatrics Direct Primary Care Program
Exploring affordable alternatives to traditional healthcare.
What does DPC mean to us, and why now?
We have been serving our community as a Rural Health Clinic for over 25 years. Most of our families have had insurance through Florida Medicaid, employers, or the Affordable Care Act Marketplace. Over this long period of time, we have witnessed disruption to both Medicaid and commercial insurance markets that have caused many people to either lose their coverage, or end up with coverage that costs a lot, but doesn’t cover much outside of hospitalization. We are aware that, over the last couple of years, many of our families have lost all coverage, with no affordable alternatives. Our hope is to restore some basic access to healthcare for these families at a reasonable price.
Our program is not insurance. It will not pay for any healthcare costs outside our clinic. However, we hope that it will allow a family to bring their children in for routine well-child check-ups, as well as sick/injury visits without the fear of an unexpectedly large bill. Additionally, for a child needing medication management for medical or mental health reasons, it would allow the child to come in more frequently to adjust medications if needed without having to worry about an office visit charge each time.
We look forward to working with our families to tailor healthcare to both to their specific needs and budget, and to create a better path forward for both patients and providers.
What is Direct Primary Care (DPC)?
A better relationship between patient and provider…
Healthcare over the last 50 years has become ever more complex, and has created many points of interference between the patient and provider.
The Direct Primary Care model recognizes that most interactions with the healthcare system are with a patient’s chosen primary care provider, and seeks to remove the barriers to care placed by insurance companies and others outside of the patient-provider relationship. By allowing providers to practice according to their license rather than insurance company rules, the provider may be able to offer more flexibility with office visits and communication (in-person, telehealth, phone, email, text), along with more testing and treatment options. Where possible, direct primary care offices will work with specialists and labs to obtain the best possible prices for cash-paying patients. As an added convenience, many offices will also have an on-site dispensary. A patient may be able to skip the line at the pharmacy because their provider has the medications needed to treat common illnesses on site.
Most direct primary care offices set up a low monthly fee per patient or family providing predictable costs for the patient or family, and better stability and support for the provider. Too often insurance companies will find ways to deny or take back payment after services and supplies are provided, with no real way to fight back.
Williston Pediatrics DPC Program
Our monthly membership fee is $75 per child.
Until we gain an understanding of how our families are using our program, we are unable to offer family-level or multiple-child discounts at this time. The agreement is for one year, but can be terminated with a 30-day written notice.
To keep it simple…
There are no sign-up fees, pro-rated fees, or refunds for terminations mid-month.
What does the fee cover?
The monthly fees pay for all office visits and any communications with the provider. It will also cover limited procedures (such as ear wax removal) where supplies and time required are minimal.
When are there additional fees?
If the patient/parent and provider agree that lab tests are needed, and the lab tests are performed by our clinic, payment is due for those tests at the time the test is performed. If labs are sent out to an outside lab, the lab will bill the patient directly at their cash pay rates. The labs have provided price lists for most tests, so we can help patients make decisions on testing.
Any medications provided by our clinic must also be paid for at the time of pickup.
As a Vaccines for Children provider, the only charge for vaccines is a $10 per shot administration fee.
Newborn circumcisions are $200.00.
How does the DPC program work?
To give an idea of how the DPC program works, here are some cost comparisons between DPC and regular cash pay pricing:
Baby’s first month (three well child visits): $75 with DPC or $305* regular cash pay.
Over 12 months, the DPC would cost $900. Just the well child check-ups for the first year under the regular cash pay system cost $780*, and do not include sick visits ($85* per visit). If a child has feeding difficulties, repeat ear infections, or other common childhood illnesses, it can be very easy to exceed $900 per year. Sick visits under the DPC are unlimited and without additional charge.
Starting mental health medication management or going through a period of medication adjustment often requires weekly to every other week appointments. In one month, under the regular cash-pay system, the costs could run between $170 – $340* for two – four visits. Under the DPC, one month is $75. A patient/parent would have to pay every month during the year, but it would allow the costs to be spread out instead of occurring all at once. Additionally, the DPC would not only cover these visits, but visits to our office for any other reason, including well-child check-ups. A year where medication management is started could involve up to seven visits ($595*) if the first medication tried works. However, it is not uncommon to have to try different medications or combinations of medications which require more visits. It could be very easy to meet or surpass the total annual DPC cost of $900 just to find the right medications without any other healthcare issue coming up.
*Reflects current cash pay pricing, and is subject to change at any time without notice.