What does the membership fee cover?
The fee covers excellent primary care through office visits with no copay. This includes the following: annual wellness exams, well-child exams, sports physicals, school physicals, chronic care office visits, follow-up visits, basic office procedures and treatment of acute illness or minor injuries, all with minimal wait times in the office. The fee also covers direct communications with your doctor: phone, text, video chat or email. Our patients will also have access to discounted labs, prescriptions and special procedures not included in the membership fees. Look at Membership Benefits for more information
Is there a sign-up fee to join?
Yes, we require a sign-up fee of $150 per individual.
Does OneMD Direct see patients of all ages?
OneMD Direct currently provides care for patients ages 16 and older.
What if I decide to cancel?
We expect to have an open, honest, respectful relationship with you. If you have voiced a complaint that we cannot satisfy together, we will gladly allow you to terminate your membership. If your membership is cancelled, you will receive a refund based on the services rendered. If you choose to rejoin, re-enrollment fees will be applied ($150/re-enrollment).
What can OneMD do for employers?
At OneMD, we know that providing health benefits to your employees is important to you. We are here to help! Any company can enroll 5+ patients for $75/employee per month. These fees can be paid pretax through a payroll deduction. An employer can choose to pay some or all of the monthly fee. By giving your employees the gift of direct pay primary care you will be providing timely access to a board certified specialist in adult primary care. No more wait or days off for doctor visits. Additionally, you will be giving them access to our wholesale medications, labs and imaging thereby significantly reducing their out of pocket expenses.
We can lower the cost of your employee health benefits up to 60% when you combine our care with a partially self-funded health plan. We work directly with an insurer who can put an employee healthcare plan together for you which combines major medical with our primary care services. Contact us for more information. Learn more here
What if I need medical attention while I’m away from home?
Because we know you well, we can streamline your care when you’re sick away from home. Many illnesses can be diagnosed and treated with a simple conversation by phone, email, text or webcam. We’ll locate the nearest pharmacy and order the medications most appropriate for your circumstances.
Can I contact the doctor after hours?
Because illness and injury do not respect regular office hours, you may call your physicians any day, at any hour. If you prefer, you may also e-mail your physician or text. Video call is also available, during office hours.
What is an internist?
An Internist or Internal Medicine Physician is a specialist who applies scientific knowledge and clinical expertise to the diagnosis, treatment and compassionate care of adults across the spectrum from health to complex illness. To learn more, click here https://www.acponline.org/about-acp/about-internal-medicine
What is OneMD Direct?
Under the Direct Primary Care (DPC) model, the patient (you) receives comprehensive primary health care directly from their DPC physician (Dr. Suji). The patient pays for this care through a monthly fee, paid directly to OneMD Direct. Because DPC practices do not participate in any insurance or plans, the providers are able to avoid the ever-increasing and costly documentation demands and administrative intrusions that come with accepting insurance. DPC practices also avoid the onerous patient data collection responsibilities which many plans impose. These require staff, time and often amount to substantial intrusions on patient privacy. Because DPC physicians avoid these obligations to insurance companies, they are free to spend that time listening to and treating patients. And because DPC physicians eliminate the significant overhead costs of participating in insurance, they can pass the savings on to you, the patient – DPC doctors are able to give compassionate, attentive and timely care at an affordable cost.
Is this concierge medicine?
Yes, sort of… but with a few distinct differences. Concierge medicine has traditionally described a medical practice for wealthy patients who pay an expensive premium upwards of $5,000 annually to see their doctor. Concierge doctors typically still participate in insurance, so the rules and restrictions of health insurance are still in place. Direct Primary Care does offer patients concierge like service and personalized primary care. However, direct primary care like OneMD Direct offers membership fees that are much more affordable (typically only $500-1000/ year) and does not participate in insurance. This makes personal healthcare without hassles affordable to everyone.
What if I’m hospitalized?
We will coordinate a patient’s care with the hospital’s team and there isn’t an extra charge for this service. If you require hospital care you will be under the care of a specialist, and that’s not covered by our fee. Other hospital charges and associated costs will still apply. That’s when your insurance will come in. Dr. Suji will then pick up your care upon discharge. She will work closely with the specialists and hospital team upon admission and discharge so that there is continuity in all of your care.
Are my medical records ever shared with insurance carriers or government agencies?
No. Patient privacy is a natural benefit of this medical model. We will never provide any third party with a copy of your records, unless you specifically ask them to do so or if OneMD Direct is subject to subpoena or search warrant.
When do I pay my fees for non-covered labs and procedures?
Charges will be added and applied to your preferred method of payment.
Medicare & Insurance Questions
Do I still need insurance?
Absolutely yes! We recommend that you do have insurance to comply with Federal Law. OneMD Direct is not an insurance plan, nor does it replace insurance. Ideally we encourage our patients to carry a high deductible, major medical plan or a plan with a health savings account. This ensures financial help should hospitalization or referral to a specialist be necessary. You should consult with your insurance provider to help you find a plan that works best with our medical model and that will meet your specific needs.
I already have insurance, won’t I be paying twice for the same services?
In many ways, patients already are paying twice: co pays, co-insurance, non-covered services, out-of-network charges, the list goes on… The average family of four pays over $4,065 in out of pocket medical expenses over the course of a year. With Direct Primary Care, like OneMD Direct, you can save hundreds of dollars in out of pocket costs – upwards of 25%. Become a patient at OneMD Direct and receive more value for your healthcare dollars.
What if I’m really healthy and only see the doctor once or twice a year? Is OneMD Direct for me?
Awesome. High five! Good health is what we all strive for. Chances are, however, you will at sometime get unexpectedly sick or have an inconvenient accident or injury. OneMD Direct will be there for you, able to give you the care you will need without long waits or expensive Urgent Care copays or ER fees. With out-of-pocket deductibles close to or over $5,000, it doesn’t take much more than a trip or two to Urgent Care or the ER for the cost of OneMD Direct to be well worth the low monthly fee.
If I have Medicare, can I join as a patient?
Yes. However, your monthly membership fee cannot be submitted to Medicare for reimbursement. You must sign a waiver every two years that declares that neither you nor your doctor will directly bill Medicare for your membership fee. Medicare and medicare supplemental insurance will still cover medical costs that you incur outside of OneMD Direct. For example, prescriptions that you fill at an outside pharmacy, or labs run at an outside lab, or hospital charges, physical therapy, x-rays and scans are covered, just to name a few. You do not lose your Medicare coverage for other medical needs just because you are a patient of OneMD Direct.
Are doctor direct’s monthly fees eligible for HSA or FSA reimbursement?
HSAs & FSAs are a smart way to pay for your health care needs with pre-tax dollars. IRS regulations make it pretty clear that all DPC services are covered medical expenses reimbursable through HSAs and FSAs, but at the same time, the IRS claims that DPC memberships are health plans, and therefore fees are not reimbursable when employees combine DPC with any other “health plan” (like the catastrophic or high deductible insurance most DPC patients need). It gets even more complicated as the Affordable Care Act and several state laws have decided DPC plans are not insurance. The issue is being addressed at the federal level with legislation called the Primary Care Enhancement Act. In the meantime, the best thing to do is check with your health plan, insurance broker or employer.
Do you treat chronic pain and anxiety?
As a general rule, WE DO NOT MANAGE CHRONIC PAIN and will not routinely prescribe narcotics or other controlled substances (Tramadol, Codeine, Hydrocodone, Soma, etc.) on an on-going basis. We recognize many people live with chronic pain and understand the necessity of controlling such symptoms. We also recognize chronic pain management as a specialized field of medicine and believe long-term treatment of chronic pain should be addressed by a board certified pain management physician in an accredited pain management center. Just as you would expect us to refer you to a general surgeon to have your gallbladder removed, or to a cardiologist for heart disease, you should expect referral to an interventional pain management specialist for chronic pain management.
As a general rule, WE DO NOT ROUTINELY PRESCRIBE CONTROLLED SUBSTANCES FOR THE LONG-TERM TREATMENT OF ANXIETY. Anti-anxiety drugs such as Xanax (alprazolam), Klonopin (clonazepam), Ativan (lorazepam) and Valium (diazepam) may be prescribed for the SHORT TERM treatment of acute anxiety, or on an infrequent “as needed” basis, but will not be prescribed for routine long-term use. Internists are experienced in the diagnosis and management of anxiety and depression and see patients with these issues on a daily basis. Anti-depressants and certain other anti-anxiety medications are not controlled substances and will be prescribed as needed.