Membership FAQ

Q: What Are Adult Direct Primary Care Services vs Traditional Adult Primary Care Services?

Adult DPC is a new healthcare model where patients receive direct and easy access to a highly trained licensed medical provider that provides the opportunity for you to experience enhanced quality care for a simple lower-cost membership fee. It is not an Urgent Care Service nor a Hospital. The adult Direct Primary Care Agreement is Not Health Insurance. The contract is directly between you and your licensed medical provider. There is no insurance involved so you know exactly what services you can receive at your monthly membership price. Therefore, there is no guessing game in the services you requested and received or the price you have to pay. There is no co-pay and no deductible. Your visits can be booked for the same day, if available, or over the next 2 - 4 business days, rather than waiting for weeks or months before being seen. You will have 15-60 minutes of visit time with your licensed provider as needed during regular business hours of the healthcare practice. If you are not able to be seen in person for any number of reasons, your licensed medical provider will be able to meet with you via a telehealth visit over the phone for no additional fee; thus saving you a potential trip to an urgent care.

The traditional Adult Primary Care Services model is where patients can be seen by a licensed medical provider for acute and chronic medical conditions. It is not an Urgent Care facility or a Hospital. The cost of these medical services is determined by the patient's medical insurance carrier's health plan coverage; whether HMO or PPO, etc. This usually includes guidelines and regulations with specific healthcare requirements/criteria to receive medical treatment including prior authorizations for procedures/medical services/treatments, and incurred fees/costs for the patient for in-network vs out-of-network providers. These insurance carriers also determine the out-of-pocket cost for patients covered by the insurance carriers; such as co-pays, deductibles, co-insurance, etc. Medical providers must be credentialed by every insurance carrier the healthcare center/provider accepts in order to adhere to state and federal regulation requirements for medical treatment. The healthcare center/provider must utilize the billing and claims process. This process is where the provider receives the agreed-upon contracted reimbursement rates for the provider/healthcare establishment that provided the medical services to the patient with medical insurance.

Q: What are the benefits of having Adult direct primary care membership services for Subscribed-cash pay-only members?

Upon research, 80% to 90% of medical conditions can be effectively addressed by a primary care provider. Unfortunately, primary healthcare organizations that only offer the traditional primary care model may find it to be more restrictive in the accessibility aspect of patients being able to consistently obtain primary care services due to a variety of reasons including uninsured status, high insurance co-pays/deductibles, etc. However, by finding a way to incorporate traditional primary care services for some members and with other members to offer adult direct primary care services, we are able to meet the needs of those who are insured and will use their insurance plan to obtain medical services and those who are not insured who want to receive our adult direct primary healthcare services through the monthly membership plan at Dr. Lanier's Healthcare and Wellness Solutions. To further clarify, these are two separate primary care services that can not be combined. Either you will be a subscribed-cash pay member with the monthly membership agreement and plan or an insured member who will follow their insurance plan requirements for receiving primary care services with our licensed medical providers.

Whether you decide to become a Subscribed member for our adult direct primary care services with a contract agreement and monthly membership or become an Insured member (utilizing your insurance plan benefits for medical services), the licensed medical provider you see will give you the time you need to address your medical needs adequately. Our goal is to continue to utilize effective time management techniques so our patients can be seen with minimal wait time.

Under the adult primary direct care services plan agreement, your membership fee includes some simple diagnostics (e.g. strep tests, urine tests, spirometry, etc.) and simple procedures such as breathing treatments, ear wax removal, etc, at no additional cost. If there are any additional charges associated with tests, they will be listed on the transparent pricing page or provided to you prior to moving forward with the medical treatment. For all tests that are done outside of the clinic, such as radiology services, discounted rates will be negotiated on behalf of cash-paying patients.

Special Note: Specific services provided by adult direct primary care practices may vary. Therefore, talk to the adult direct Primary Care (adult DPC) practices near you to understand exactly what their memberships include. In general, many, not all, adult DPC practices provide:

Treatment of common everyday problems like colds, flu, strep throat, rashes, burns, joint injuries, and some minor wounds.

Preventative screenings, like referral for colonoscopies, pap smears, and in-house EKGs.

Management of chronic conditions like asthma, diabetes, high blood pressure, high cholesterol, or thyroid disorder.

Some may provide a number of additional services including minor in-clinic procedures such as joint injections, stitches, etc, and nutrition counseling. These services are often offered for a small additional fee.

Referral to specialist care. If you have a medical issue that can’t be handled by your primary care medical provider, you’ll be referred to a licensed medical specialist who can continue your treatment. Your adult DPC licensed medical provider will work closely with the specialist to make sure there is seamless continuity of care.

Annual full-body physical exam and laboratory tests. Often, your medical provider will do a comprehensive review of systems at your very first in-person appointment and yearly thereafter.

Continuity of care. If you get admitted to a hospital, your medical provider will help your continuity of care by taking an active role in your care throughout by consulting the hospital medical providers assigned to you and having the member reach out to the office or online to schedule post-hospital follow-up evaluation visit with our medical provider.

Q: How much do Adult Direct Primary Care Services Cost?

The typical monthly fee varies slightly based on the Adult DPC practice and the included services. However, the access and the quality of care you receive at Dr. Lanier's Healthcare & Wellness Solutions, where we offer traditional adult primary care services AND adult direct primary care services, can be hard to find anywhere else.

The price is unbeatable for the value and high-quality services you receive.

Most Adult DPC practices have made an effort to establish outside relationships with local radiology centers and laboratories. What does this mean for the Subscribed membership patient? It means you can get x-rays, blood tests, pathology screens, MRIs, and more tests not mentioned, for low cash prices.

Q: Can Adult Direct Primary Care membership services save you money?

Yes. Absolutely, if you consider the following common healthcare scenarios, you will definitely see where the savings add up:

As an Adult Direct Primary Care (Adult DPC) subscribed member, the majority of your healthcare will be taken care of by your adult direct primary care provider. There are no co-insurance, no co-pays, no deductibles to stress you out about. However, utilizing a traditional primary care insurance health plan coverage can cost you a significant amount of expense when you have to pay all the co-pays, co-insurance, and high deductibles required by your insurance carrier health plan coverage. Hence, most Adult DPC patients save a lot by choosing a lower premium/high deductive insurance plan and using their insurance coverage for other outside healthcare facilities such as for hospital or urgent care visits. Then, become a subscribed cash-only member with the Adult Direct Primary Care membership plan. If you have a lower deductible, but higher premium health plan you may be paying a lot of money monthly for insurance while never needing to receive the insurance coverage for an expensive hospitalization or specialty care. If you end up having a serious illness or have a case that requires hospitalization or expensive specialized care you are likely to hit a higher deductible fast which makes a lower premium but higher deductible a cost-effective way for Adult DPC patients who choose to keep their traditional insurance.

If you develop an acute illness such as food poisoning or have an insect bite without any respiratory complication/anaphylaxis, you may end up going to an urgent care or to the emergency room which can cost you hundreds to thousands of dollars. Your Adult DPC monthly membership gives you the option to call your medical provider for a consultation that could save you that trip to the hospital or urgent care and that would cost a lot of money. Please take note: There are some urgent medical cases for which your Adult DPC medical provider would still recommend that you go to a higher level of care, such as the Emergency Room (ER), for your own safety. However, you will have the opportunity to have that discussion with your medical provider, and based on your medical provider's recommendation, you can make that decision whether or not you will follow the medical recommendation of your medical provider or decide not to go to the ER; ensuring you are fully aware that if you decide not to go to the emergency room for evaluation, it could result in life-threatening complications and/or worsening of your medical condition(s).

The goal of Dr. Lanier's Healthcare & Wellness Solutions' traditional and adult direct primary care services is to give patients access to high-quality healthcare service from their medical providers who focus on delivering optimal healthcare services with a holistic and personalized approach along their wellness journey. We take pride in addressing health concerns timely, adequately, and on a comprehensive level by taking an active role in our patient's wellness journey and advocating for them. Adult DPC medical providers will save individual patients and the entire health system a significant amount of money by focusing on providing the primary care services patients need to effectively manage their chronic medical conditions which will result in a decrease in re-hospitalization visits.

Let's discuss the cost of our Adult Direct Primary Care monthly membership service: For a monthly fee starting out costing <$200 (you will have your medical provider at your fingertips, without co-pay or deductible. Imagine how much it would cost if a patient had this type of access and benefit to their regular doctor using the conventional payment models).

Q: Do I still need insurance as a direct primary care patient?

Yes, we still recommend that you get health insurance, a high deductible health plan with a lower premium is most suited for those who join an Adult DPC practice. See above.

Your Adult DPC membership is not an insurance plan; you’ll still need insurance if you have a major health problem that may require seeing a specialist, an admission to a hospital, or a visit to the emergency room. Don’t forget though, your Adult DPC medical provider will be available to assist you with your coordination of care as indicated so the continuity of care continues and the transfer of care is as smooth as possible.

Q: Should I join a direct primary care practice monthly membership if I am healthy?

Absolutely. Your Adult DPC medical provider will work with you to keep you healthy and will partner with you to create a wellness plan to improve your quality of life, that will keep you active, and strive to keep you in good health through your golden years. Investing in a preventive health plan including in the areas of maintaining a healthy lifestyle by maintaining a healthy diet, exercise regimen, mental health, and sleep habits is like protecting yourself from the medical conditions that suddenly cause a decline in your physical and mental health as we get older and realize we should have taken better care of ourselves, health-wise, in our younger years.

Q: What do I have to do to become a Subscribed member at Dr. Lanier's Elite Healthcare & Wellness Solutions Adult DPC?

If you are ready to be a member, just go to the pricing page and sign up today! If you want more information you could also contact our office for additional details.

If you choose to be a member we highly encourage you to commit to at least 3 months of membership. Here is why:

At Dr. Lanier's Elite Healthcare & Wellness Solutions, besides receiving Elite and Optimal medical care services, we provide essential services like patient engagement and health and wellness education so you are empowered to take the necessary steps to improve your quality of life journey. These services will be mostly concentrated during the first 3-months of your membership. Our extensive healthcare experience has shown us that certain things in life are just not as quick as we would like them to be because more time is needed to be thorough and organized. Therefore, the process of obtaining medical records, organizing those records, and reviewing and summarizing all takes time. As this process is being done, we can still start building rapport and finding out individual patients’ wishes/preferences, and values before creating an amazing personalized treatment and health plan for you.

Q: Why don't you enroll Medicare Patients in the Subscribed adult direct primary care membership services?

This is not our choice. This has to do with Medicare’s rules surrounding reimbursable benefits for covered services. We hope these rules change in the future so we can extend our adult direct primary care services to Medicare patients, but at this time we can not enroll Medicare patients into our Subscribed membership program. However, Medicare patients can be seen by our medical providers under our traditional primary care services once all credentialing requirements have been completed and approved.

Q: Does Dr. Lanier's Elite Healthcare & Wellness Solutions work with Insurance companies?

Yes and NO.

Dr. Lanier's Elite Healthcare & Wellness Solutions provides the following services with/without working with insurance carriers:

Adult Direct primary care services to subscribing members. NO, we don’t work with/bill the health insurance companies. All our services are included in the membership fees.
Adult Primary care Services for Insured members. YES, we work with/bill your health insurance carrier that we are credentialed with and you are responsible for all co-pays, deductibles, co-insurance, etc. that your insurance carrier requires you to pay for/toward medical services you receive. Individuals pay these required insurance carrier fees for select services at the time of service.
Additional healthcare services we provide such as Hormone replacement therapy (estrogen replacement for women and testosterone replacement for men that meet HRT criteria) and any other cash-pay healthcare services not mentioned: NO, we offer these services on a cash-pay basis only. Price list and details of specific cash-pay healthcare services will be provided upon request.