What is Direct Specialty Care?

Direct Specialty Care (DSC) represents independent, physician-led practices that strive to partner with patients. It’s a simple relationship between you and your specialist. DSC offers a more personalized approach to your medical care and prioritizes quality of care over volume of visits. It eliminates all the middlemen between the patient and the physician. This care model provides transparent pricing, reduces the interference of insurance companies, and focuses on strengthening the relationship between the patient and their doctor.

In a Direct Pay Membership model, patients become members of a practice and, for a monthly subscription, gain prompt access to their doctor with in-person and telehealth options as well as longer visit times.

The direct patient care healthcare model puts the patient in complete control of their healthcare options. Additionally, because the physician does not bear the overhead costs imposed by the insurance companies, cost savings are passed onto the patient, leading to lower prices than the traditional insurance-based healthcare model. This results in affordable, high-quality, individualized medical care tailored specifically to the patient’s needs, not what the insurance company dictates. Given that high deductible insurance plans are getting increasingly expensive every year, you may find that you SAVE money by paying a discounted cash price for care.

The Direct Specialty Care healthcare model restores the unique doctor-patient relationship that physicians and patients desire.

The main tenets of direct specialty care are as below:

1. High-quality care:

Physicians perform their best work when they focus on you, hear your concerns, and conduct the appropriate physical exams to diagnose and formulate a treatment plan. Doctors hate rushing in and out of a new exam room every 15 minutes as much as you do! There is a better way! DSC offers a relaxed and comfortable environment for receiving high-quality specialty care, with a focus on individualized care plans for patients with complex needs or who have had limited success with traditional care. Here, you can receive the extra time you need in a respectful, supportive environment to improve your health.

2. Access:

The Direct Specialty model of care facilitates timely evaluation and treatment. We can see you for routine visits as well as during urgent concerns. You have easy direct communication with the doctor via the patient portal, phone or email. This model allows better access to care and leads to less frequent visits to Urgent Care or the Emergency Room for our patients. 

3. Affordability:

Making office-based appointments and basic procedure care affordable.

4. Price transparency:

Peds Happy Hearts, and most DSC clinics, will post their prices directly on their website so you know how much the visit will cost BEFORE you come in. There will be no surprise billing or extra costs. Prices are 100% transparent. Most patients pay less for their care than in the traditional insurance-based healthcare model.

No copay, no insurance billing, no prior authorizations

You deserve the best medical care without any hassle. That’s why we offer direct patient care practices that don’t require copays, insurance billing, or prior authorizations. You can choose your medical doctor, as we are considered “out of network.” We accept health savings and flexible spending accounts as payment for our top-notch medical services. If you need to submit a claim to your private insurance company for reimbursement, we’ll provide you with all the necessary information. However, please note that we cannot guarantee reimbursement from your insurance company. It’s important to check with your insurance provider to understand their reimbursement rules. If you have any questions, don’t hesitate to contact your insurance company directly. Trust us to provide you with the best medical care, without any unnecessary stress.

HOW DOES IT WORK?

It is as simple as establishing a direct contract with your physician.  All patients are accepted.  There are no additional co-payments or bills submitted to your insurance. You can receive personalized care when you need it the most. 

Patients can join our practice with a monthly membership fee or choose to see us on an “as needed” or “pay as you go” basis.  Patients who enroll in our membership plan will have direct access to their physician through office visits, telemedicine visits, phone calls, and patient portal messaging at no additional cost. 

Our Membership Plan includes the following:

Scheduled visits with your doctor (in-person or telehealth)

Access to the patient portal

Access to urgent visits when needed

Electrocardiograms (ECGs) when needed

Additional cardiac imaging (Echocardiogram, electrocardiograms (ECGs), and heart monitors) at a more significant discount

A thorough review of outside medical records by your doctor

Forms/documents filled out by your doctor when needed

*You will still be able to use your health insurance benefits for laboratory tests, imaging studies, prescription medications, and infusion services.

Direct Specialty Care

• Your doctor will see you promptly, and there will be minimal time in the waiting room
• You will have plenty of time to ask questions during your visit
• We will always treat you like family
• You will have access to both in-person and telehealth visits with your doctor
• Your doctor will work together with you to come up with a treatment plan
• You do not need a referral to see your doctor
• You will be able to see your doctor even if you are uninsured
• You will not receive any surprise bills after your visit

Traditional Healthcare

• It may take several months to see your doctor
• Waiting room time is unpredictable and often long
• The visits may be short and impersonal
• You may have difficulty reaching your doctor or their staff directly
• For urgent visits, you may wait weeks to see your doctor or may be redirected to another physician
• If the practice does not accept your insurance, you cannot be seen by the doctor/specialist
• You may receive surprise bills for the visit and other services performed