What is Direct Primary Care? Direct Primary Care is a model of healthcare in which we remove the complex administrative burdens and accompanying inflation of costs associated with the involvement of health insurance companies in the patient-physician relationship. We don't bill your health insurance to get paid. Instead of relying on traditional health insurance networks and the problems that come with them, we use monthly membership fees to cover the costs of healthcare. When we free ourselves from the hassles of the old system, we find the flexibility to achieve more for the health of our patients, our families, and our communities. |
Is this "concierge medicine"? Not exactly. Most concierge practices still send a bill to health insurance companies to get paid, while additionally charging their patients an extra fee for more personalized access. Concierge-style practices are also often more expensive than most direct primary care practices, and thus they are less accessible for many people. In a direct primary care practice, we do not ask for payments from health insurance companies and we cover the costs of the majority of our services by charging a monthly membership fee. There are also many different styles of direct primary care, with varying levels of access to the physician and different boundaries that are unique to each direct primary care practice. Many of us in direct primary care have a style that we say is like "having a doctor in the family." For example, if you have a sibling or a close cousin who is a physician, you might send a text message or email, or perhaps call them on the phone to discuss some concerns during the daytime. However, a call that is late at night or very early in the morning would usually only be made if you thought there was an urgent, serious situation that could not wait until another time. We are similar in our approach. If there's a true emergency, Dr. Joshi will take a phone call at night, as well. But a lot of things are better to discuss during the daytime if there isn't something truly dangerous going on. |
Do you take walk-in appointments?
Even though we offer same-day appointments in many situations, these appointments still require the patient/family member to contact the office in advance to schedule an appointment. We do not take completely unplanned walk-in visits.
Even though we offer same-day appointments in many situations, these appointments still require the patient/family member to contact the office in advance to schedule an appointment. We do not take completely unplanned walk-in visits.
What is unique about The Healthy Futures Pediatric Clinic?
The Healthy Futures Pediatric Clinic is one of the first direct primary care pediatrician practices in the far northern suburbs of Dallas centered around McKinney/Frisco/Prosper/Allen/Northern Plano and also one of a small handful of pediatrician direct primary care practices in the entire Dallas-Fort Worth Metropolitan area during a time in which this type of practice model is gradually beginning to spread nationwide.
The practice is also different from another separate growing trend of membership-based healthcare through very large corporate networks of physicians and other practitioners that involve a lot of long-distance healthcare visits conducted virtually. While secure video-call appointments are one of the options available in certain scenarios in our practice, a lot of our care also still happens in person, with YOUR OWN physician, inside a real building with a real examination and face-to-face conversation that a technology-heavy nationwide network membership might NOT be able to provide with the same sense of personal care. Those large membership-based health systems may not feel the same as "having a doctor in the family."
Lastly, unlike other types of physicians who may see a wider age range of patients, Dr. Joshi is a board-certified pediatrician. He has spent most of the time during his training solely focused on the healthcare of young people through early adulthood. Because of such training, pediatricians are generally more comfortable in working with families of infants, children, adolescents, and young adults with many health concerns when compared to many other types of healthcare providers. Here at The Healthy Futures Pediatric Clinic, Dr. Joshi will see patients from age zero through generally around 22 years old (although this is flexible to some extent.)
The Healthy Futures Pediatric Clinic is one of the first direct primary care pediatrician practices in the far northern suburbs of Dallas centered around McKinney/Frisco/Prosper/Allen/Northern Plano and also one of a small handful of pediatrician direct primary care practices in the entire Dallas-Fort Worth Metropolitan area during a time in which this type of practice model is gradually beginning to spread nationwide.
The practice is also different from another separate growing trend of membership-based healthcare through very large corporate networks of physicians and other practitioners that involve a lot of long-distance healthcare visits conducted virtually. While secure video-call appointments are one of the options available in certain scenarios in our practice, a lot of our care also still happens in person, with YOUR OWN physician, inside a real building with a real examination and face-to-face conversation that a technology-heavy nationwide network membership might NOT be able to provide with the same sense of personal care. Those large membership-based health systems may not feel the same as "having a doctor in the family."
Lastly, unlike other types of physicians who may see a wider age range of patients, Dr. Joshi is a board-certified pediatrician. He has spent most of the time during his training solely focused on the healthcare of young people through early adulthood. Because of such training, pediatricians are generally more comfortable in working with families of infants, children, adolescents, and young adults with many health concerns when compared to many other types of healthcare providers. Here at The Healthy Futures Pediatric Clinic, Dr. Joshi will see patients from age zero through generally around 22 years old (although this is flexible to some extent.)
Can you see Medicaid or CHIP Patients? Yes! A unique feature of direct primary care is that we don't rely on insurance networks for our payments, so it doesn't matter whether a patient has a commercial insurance plan, Medicaid, CHIP, or no insurance at all. However, since we generally bill a monthly fee instead of billing for individual services or visits, we don't take payments from Medicaid or CHIP. We reserve a limited number of reduced-cost memberships, and patients with Medicaid or CHIP are welcome to check availability. There will still be a monthly fee (at a reduced price) paid by patients who have Medicaid or CHIP. These reduced-price fees are paid directly by the patients to the clinic. Legally, a form must be signed to acknowledge that we are billing patients directly and that the membership cannot be paid for by Medicaid or CHIP. Additionally, Dr. Joshi is signed up as a Medicaid "ordering, referring, prescribing" provider, which means that patients on Medicaid can still have their Medicaid plans pay for prescriptions ordered by Dr. Joshi. He can also refer Medicaid patients to specialists who accept Medicaid or send them for lab work or other services in places that accept Medicaid, and Medicaid will be able to pay for those services because he has signed up to be authorized by Medicaid to prescribe medications, refer to outside providers, and order tests done elsewhere for which Medicaid will pay on the patients' behalf without requiring the prescriptions/orders/referrals to come from a different Medicaid-assigned physician. |
Does The Healthy Futures Pediatric Clinic Bill My Health Insurance? No. As a direct primary care practice, we do not participate in contracts with health insurance plans and do not rely on those plans for payments. This allows us to be free from contract obligations that typically prevent most traditional medical practices from being able to charge lower, wholesale prices for patients when ordering various medical tests and procedures. The freedom from such contracts allows the practice significant leeway in choosing its own pricing, scheduling, and tackling daily administrative issues. This, in turn, benefits our patients because we try to pass the savings along to them. |
Should I Still Keep My Health Insurance?
Yes, most definitely!
But wait, doesn't that increase my expenses if my health insurance premiums are already taking some money out of EACH of my paychecks AND I'm also going to pay a separate membership fee to The Healthy Futures Pediatric Clinic because you won't take my health insurance? HOW is this going to help my family?!!
If you want the details, read below....
For a moment, let's consider the way automobile insurance works. There is a premium that is paid for auto insurance coverage. The coverage helps with costs when you have a motor vehicle accident or other major damage such as hail damage. However, your auto insurance does not need you to complete any paperwork or get approval for specific brands or locations if you're simply getting a routine oil change or new tires. If auto insurance got involved for every smaller expense, your auto insurance premium would cost a lot more, and obtaining simple care for your car would also require a lot more paperwork, time, energy, long lines, and exhausted people. Fortunately, auto insurance simply covers the major expenses and requires paperwork for those situations, while the easier "routine" care is an out-of-pocket expense. This actually keeps the auto insurance premium bill lower than it would otherwise have been for car owners.
Now, let's look at health insurance coverage with a similar perspective. In direct primary care, you have access to a system that won't bill you separately for simple sick visits or routine chronic follow up visits, nor for preventive visits, because it's covered by a monthly fee. You can then choose a cheaper health insurance plan that covers less of the routine healthcare expenses and mostly covers things like major tests/procedures, hospitalizations, physical therapy, surgeries, etc, since your membership fees cover the other care already. You can then use your health insurance more like the way auto insurance covers larger things, but does not cover the smaller things. For some people, switching to a lower-premium, higher-deductible health plan and then enrolling in membership at a direct primary care practice may potentially reduce overall annual healthcare expenses when compared to a traditional higher-premium, lower-deductible plan combined with using a traditional medical practice. For others, the total expenses may end up being similar for either type of arrangement, while in some cases, they end up being slightly higher. Even in those situations, some people have concluded that the benefits of direct primary care are worth it.
Yes, most definitely!
But wait, doesn't that increase my expenses if my health insurance premiums are already taking some money out of EACH of my paychecks AND I'm also going to pay a separate membership fee to The Healthy Futures Pediatric Clinic because you won't take my health insurance? HOW is this going to help my family?!!
If you want the details, read below....
For a moment, let's consider the way automobile insurance works. There is a premium that is paid for auto insurance coverage. The coverage helps with costs when you have a motor vehicle accident or other major damage such as hail damage. However, your auto insurance does not need you to complete any paperwork or get approval for specific brands or locations if you're simply getting a routine oil change or new tires. If auto insurance got involved for every smaller expense, your auto insurance premium would cost a lot more, and obtaining simple care for your car would also require a lot more paperwork, time, energy, long lines, and exhausted people. Fortunately, auto insurance simply covers the major expenses and requires paperwork for those situations, while the easier "routine" care is an out-of-pocket expense. This actually keeps the auto insurance premium bill lower than it would otherwise have been for car owners.
Now, let's look at health insurance coverage with a similar perspective. In direct primary care, you have access to a system that won't bill you separately for simple sick visits or routine chronic follow up visits, nor for preventive visits, because it's covered by a monthly fee. You can then choose a cheaper health insurance plan that covers less of the routine healthcare expenses and mostly covers things like major tests/procedures, hospitalizations, physical therapy, surgeries, etc, since your membership fees cover the other care already. You can then use your health insurance more like the way auto insurance covers larger things, but does not cover the smaller things. For some people, switching to a lower-premium, higher-deductible health plan and then enrolling in membership at a direct primary care practice may potentially reduce overall annual healthcare expenses when compared to a traditional higher-premium, lower-deductible plan combined with using a traditional medical practice. For others, the total expenses may end up being similar for either type of arrangement, while in some cases, they end up being slightly higher. Even in those situations, some people have concluded that the benefits of direct primary care are worth it.
If my kids have to go to the hospital, who sees them? What happens with referrals to specialists or to other services like physical therapy, such as after a sports-related injury?
Long ago, any time that a patient was hospitalized, the patient's primary doctor would often still visit them and be one of the several people directly involved in their hospital care. Over recent decades, a lot of that has changed and there are often dedicated teams of doctors in hospitals who specifically care for patients during their hospital stay. At The Healthy Futures Pediatric Clinic, Dr. Joshi will get updates from the members of hospital teams who are involved in directing your child's care and also share information with your child's hospital team as appropriate for his or her medical needs. And when your child is out of the hospital again, we will follow up at the office to make sure that things are going smoothly in the recovery process. Since the care at hospitals is not covered by membership, your health insurance is billed by those facilities.
Meanwhile, for specialists or other referrals, we can recommend specialists or refer your child to various places, and those places will either bill your insurance or bill you directly, depending on your health insurance arrangements, since membership in our clinic does not cover the care provided by these outside providers/locations.
Long ago, any time that a patient was hospitalized, the patient's primary doctor would often still visit them and be one of the several people directly involved in their hospital care. Over recent decades, a lot of that has changed and there are often dedicated teams of doctors in hospitals who specifically care for patients during their hospital stay. At The Healthy Futures Pediatric Clinic, Dr. Joshi will get updates from the members of hospital teams who are involved in directing your child's care and also share information with your child's hospital team as appropriate for his or her medical needs. And when your child is out of the hospital again, we will follow up at the office to make sure that things are going smoothly in the recovery process. Since the care at hospitals is not covered by membership, your health insurance is billed by those facilities.
Meanwhile, for specialists or other referrals, we can recommend specialists or refer your child to various places, and those places will either bill your insurance or bill you directly, depending on your health insurance arrangements, since membership in our clinic does not cover the care provided by these outside providers/locations.
What is The Healthy Futures Pediatric Clinic's approach to vaccines? We generally follow the vaccination schedule recommended by the American Academy of Pediatrics (AAP) and by the United States Centers for Disease Control and Prevention (CDC). For families who are hesitant about vaccines, we can take our time to explain the benefits, answer questions, and help you feel comfortable with the care and safety of your children. We acknowledge that just like many common medications we all take, which also have the potential for rare harmful side effects, vaccines also occasionally (but RARELY) carry some risks for a SMALL PERCENTAGE of the general population. However, based on very large amounts of scientific information available, we can feel confident that the specific vaccines that are approved and recommended by the AAP and CDC typically carry risks that are MUCH LOWER than the risks associated with taking various over-the-counter medications. For example, ibuprofen, which is the medication found in brands such as Advil or Motrin, can increase the risks of intestinal bleeding as well as heart attacks and strokes. Yet most parents will give their children a dose of Children's Motrin when they have a fever. Meanwhile, in RARE situations, ibuprofen has even caused a life-threatening skin peeling condition (Stevens-Johnson Syndrome) in some people and led to their hospitalization in intensive care units to keep them alive. Vaccines, meanwhile, have a MUCH SAFER risk profile than most medications that people casually give to their children already. With such a low risk profile when compared to most medications, and the clear, significant benefit of reducing the risks of severe complications (sometimes life-threatening ones) from infections, vaccines remain one of the BEST public health inventions in modern medicine. Keeping all of that in mind, when there are specific concerns for specific patients, like someone who should avoid influenza vaccines due to a previous history of having Guillian-Barre Syndrome, or if there is a patient who has a family history of multiple family members who all had an adverse reaction to some very specific vaccine or component of a vaccine, we understand that one singular approach might not be the best for every patient and that there are exceptions for those cases. That being said, the vast majority of the time, and for most people, vaccination is a major step in helping to maintain healthy families and communities. |
If you don't accept health insurance, how do we get vaccines from the clinic? Are they also covered by the membership fee? We have made arrangements so that there should not be any additional cost to our patients for most vaccines administered in our office. Due to our costs of being a small start-up clinical office that is still newly establishing itself and growing, some of the vaccines that are typically given to older kids will be obtained for our older patients by referring them to nearby pharmacies to receive those vaccines. Most health insurance plans are required to provide full coverage for preventive vaccines, so even if our patients might go to a pharmacy to receive some of the vaccines that we've prescribed, there should usually be no extra cost to our patients for those vaccines. Meanwhile, for some of our patients who are either uninsured or have Medicaid (or would have been Medicaid-eligible), we can STILL get them vaccinated without extra costs by sending them to the local health department for the specific vaccines that we might not have in the office. And for all of the other vaccines that we actually keep in our office, we don't charge our patients when they receive those vaccines, regardless of their insurance status. Thus, in any situation, there shouldn't be extra costs for the majority of the routine vaccines given to our patients. |
Is this type of practice helpful for my kids even if they don't get sick often or if they don't need frequent checkups?
The traditional healthcare system in the United States typically encourages people to avoid seeking medical consultations unless they are in a situation that requires an urgent intervention. When there is a membership model without extra charges for appointments, it encourages people to check in with healthcare professionals BEFORE a problem actually arises. This allows an emphasis on maintaining or striving to achieve WELLNESS in a way that the mainstream healthcare system does not necessarily support. Over time, we get to know our patients and their overall health, their needs, and their health-related goals. We can try to help our patients achieve health/wellness goals even when things are already "going well." Hopefully, this prevents people from having more complicated health issues later on. This model encourages communication between patients' families and the healthcare provider in a way that will hopefully create a sense of teamwork, in which we partner with families to try to achieve the best health outcomes for our patients.
Apart from the benefits mentioned above for patients who don't end up being sick often, there are also other situations in which our membership-based model is helpful. Over the past few years, many medical offices have started charging between 30 and 50 dollars per request when a patient needs to have any forms filled out by the office if the forms are not submitted during an actual office visit. Meanwhile, some healthcare organizations have also started to charge for responding to patient phone calls or messages. In that type of system, let's imagine that someone has two appointments during one month in which there was one episode of strep throat and then one episode of an ear infection. The child also has mild asthma that is generally well-controlled. However, at the end of the month, school is about to start again at the end of the summer vacation. The school reminds the parents that a note from the physician is needed for the school nurse to be able to keep asthma medications available at the office. Thus, the family ends up requesting a physician note for the school nurse for managing the asthma. In the traditional system, the family might end up paying a 40-dollar copayment for each of the two visits ($80 in total), PLUS another 50 dollars for the school note to be completed. In case the family calls twice to discuss concerns related to managing the ear infection, and the traditional practice might charge 25 dollars each for responding to the two calls, then the total cost for that month will be 180 dollars. However, in our version of direct primary care, there won't be fees for the individual visits, nor any fee for completion of routine forms, and no extra charges for phone consultations. If the monthly fee is less than 180 dollars per month in this specific scenario, the membership would have been better for this individual child. This simple scenario doesn't even involve other siblings that might suddenly have increased needs for medical attention in the following month while the first sibling is doing very well. And it also does not consider the benefit of having a long-term and personalized professional relationship with the doctor. One in which you can send a quick text message in the middle of the afternoon one day about a non-urgent (but still relevant (ahem, no forwarding of random internet memes, please)) question about your kids' health, and the doctor will reply either later that day or within the next day with some useful answer. (In this example, it was a casual, non-urgent question. In more urgent situations, obviously the response would be much sooner than within a day or two.)
The traditional healthcare system in the United States typically encourages people to avoid seeking medical consultations unless they are in a situation that requires an urgent intervention. When there is a membership model without extra charges for appointments, it encourages people to check in with healthcare professionals BEFORE a problem actually arises. This allows an emphasis on maintaining or striving to achieve WELLNESS in a way that the mainstream healthcare system does not necessarily support. Over time, we get to know our patients and their overall health, their needs, and their health-related goals. We can try to help our patients achieve health/wellness goals even when things are already "going well." Hopefully, this prevents people from having more complicated health issues later on. This model encourages communication between patients' families and the healthcare provider in a way that will hopefully create a sense of teamwork, in which we partner with families to try to achieve the best health outcomes for our patients.
Apart from the benefits mentioned above for patients who don't end up being sick often, there are also other situations in which our membership-based model is helpful. Over the past few years, many medical offices have started charging between 30 and 50 dollars per request when a patient needs to have any forms filled out by the office if the forms are not submitted during an actual office visit. Meanwhile, some healthcare organizations have also started to charge for responding to patient phone calls or messages. In that type of system, let's imagine that someone has two appointments during one month in which there was one episode of strep throat and then one episode of an ear infection. The child also has mild asthma that is generally well-controlled. However, at the end of the month, school is about to start again at the end of the summer vacation. The school reminds the parents that a note from the physician is needed for the school nurse to be able to keep asthma medications available at the office. Thus, the family ends up requesting a physician note for the school nurse for managing the asthma. In the traditional system, the family might end up paying a 40-dollar copayment for each of the two visits ($80 in total), PLUS another 50 dollars for the school note to be completed. In case the family calls twice to discuss concerns related to managing the ear infection, and the traditional practice might charge 25 dollars each for responding to the two calls, then the total cost for that month will be 180 dollars. However, in our version of direct primary care, there won't be fees for the individual visits, nor any fee for completion of routine forms, and no extra charges for phone consultations. If the monthly fee is less than 180 dollars per month in this specific scenario, the membership would have been better for this individual child. This simple scenario doesn't even involve other siblings that might suddenly have increased needs for medical attention in the following month while the first sibling is doing very well. And it also does not consider the benefit of having a long-term and personalized professional relationship with the doctor. One in which you can send a quick text message in the middle of the afternoon one day about a non-urgent (but still relevant (ahem, no forwarding of random internet memes, please)) question about your kids' health, and the doctor will reply either later that day or within the next day with some useful answer. (In this example, it was a casual, non-urgent question. In more urgent situations, obviously the response would be much sooner than within a day or two.)
What do we do if we want to explore a bit more about possibly enrolling? Do we contact the office?
Yes! Feel free to email the office or leave a voicemail on the office line, and we will get in touch with you so that we can schedule a free "Meet and Greet" in which you all can get to know a bit more about the practice to see if it's a good fit for your needs.
Yes! Feel free to email the office or leave a voicemail on the office line, and we will get in touch with you so that we can schedule a free "Meet and Greet" in which you all can get to know a bit more about the practice to see if it's a good fit for your needs.
***Disclaimers***
Reading this website by an individual, family, or other group does not by itself imply or constitute a patient-physician relationship between those reading the site and The Healthy Futures Pediatric Clinic or its staff. It also does not imply or constitute specific financial or legal advice that will suit the specific needs or situations of individuals/families/groups reading this website. The information presented here also does not come from an "insurance-related expert," and each insurance policy may have various details that will affect specific individuals differently.
The communication presented in this site is intended solely for general informational purposes that may potentially be of benefit to its users, but the general information does NOT take into account the various specific situations of its readers. The specific situations/circumstances of the site's readers may influence the actual applicability or outcomes of the information presented. Prior to making decisions affecting your health insurance or finances, it is recommended to discuss your ideas with individuals licensed to provide you with official financial or insurance-related advice.
Similarly, using this website also does not substitute for a patient-physician relationship. Any health-related actions you plan to take should be DISCUSSED with YOUR healthcare provider BEFORE implementing such actions, even if the idea is presented anywhere on this site (including in the blog). Communication presented on this site (and on the blog) is for GENERAL informational purposes, and does not constitute specific medical advice or other health-related advice. The ideas presented online might NOT be applicable in your SPECIFIC situation, based upon your own specific health issues or other unique circumstances.
Reading this website by an individual, family, or other group does not by itself imply or constitute a patient-physician relationship between those reading the site and The Healthy Futures Pediatric Clinic or its staff. It also does not imply or constitute specific financial or legal advice that will suit the specific needs or situations of individuals/families/groups reading this website. The information presented here also does not come from an "insurance-related expert," and each insurance policy may have various details that will affect specific individuals differently.
The communication presented in this site is intended solely for general informational purposes that may potentially be of benefit to its users, but the general information does NOT take into account the various specific situations of its readers. The specific situations/circumstances of the site's readers may influence the actual applicability or outcomes of the information presented. Prior to making decisions affecting your health insurance or finances, it is recommended to discuss your ideas with individuals licensed to provide you with official financial or insurance-related advice.
Similarly, using this website also does not substitute for a patient-physician relationship. Any health-related actions you plan to take should be DISCUSSED with YOUR healthcare provider BEFORE implementing such actions, even if the idea is presented anywhere on this site (including in the blog). Communication presented on this site (and on the blog) is for GENERAL informational purposes, and does not constitute specific medical advice or other health-related advice. The ideas presented online might NOT be applicable in your SPECIFIC situation, based upon your own specific health issues or other unique circumstances.