Insurance & billing
Two ways to be seen — and one phone call to find out which is yours
We treat patients under the traditional fee-for-service model using their insurance carrier, and we offer Direct Primary Care for those without insurance or who choose not to use it. Coverage is specific to your policy, so please verify it with us before your first visit.
Before you book
Call us to verify your coverage
The carriers we work with are listed below. Even so, plan networks change and two policies from the same company can be treated differently — so seeing a familiar logo is a good sign rather than a guarantee. Call us with your card in hand and we'll check your specific policy. It takes a few minutes.
Prefer to write? Email help@primarycare369.us — please do not include medical details.
Carriers
Insurance we work with
Coverage depends on your individual plan. Please call to confirm before your appointment.
Carrier logos are shown for identification only and remain the property of their owners. Listing does not imply endorsement, and participation can change — always verify with the office before your visit.
How billing works
Traditional model, or membership
The clinical care is identical. What differs is who receives the bill, how long the visit runs, and when you find out what you owe.
| Traditional Fee-for-service | Membership Direct Primary Care | |
|---|---|---|
| Who pays | Your insurance carrier, plus your copay, coinsurance and deductible. | You, as a periodic membership payment. No claim is filed. |
| Visit length | Standard appointment lengths set around the visit type. | Extended visits — time allocated to the problem, not to the billing code. |
| Knowing the cost | Final responsibility is set when your insurer processes the claim. | Known in advance and set out in your membership agreement. |
| Access between visits | By phone and through the patient portal during office hours. | Direct access to the practice, plus priority scheduling for acute concerns. |
| Best suited to | Patients with active coverage who want their plan to pay for primary care. | Patients without insurance, or who would rather not use a plan for primary care. |
| What it does not cover | Elective wellness procedures; anything your policy excludes. | Hospitalization, surgery, specialists, imaging and medications — it is not insurance. |
Your first visit
Six things to bring
Registration is faster and billing is more accurate when these arrive with you. New patients can complete registration ahead of time through the patient portal.
Your insurance card
The physical card or a clear photo of both sides. If your plan changed recently, bring the current card even if you have used us before — a stale plan number is the single most common cause of a surprise bill.
Photo identification
A driver's license, state ID or passport. We verify identity against the policy so claims are filed under the right person.
A current medication list
Everything you take, including over-the-counter medicines, vitamins and supplements, with doses if you know them. A photo of the bottles works just as well as a list.
Records that already exist
Recent lab work, imaging reports, hospital discharge summaries or specialist letters. Bringing them avoids repeating tests you have already paid for.
Any referral your plan requires
Some plans require a referral or prior authorization before a visit is covered. If yours does, obtain it before your appointment — we cannot apply one retroactively.
A method of payment
Copays, coinsurance and any amount applied to your deductible are collected at the time of service, as is payment for self-pay services.
Not covered by insurance
Elective and wellness procedures are self-pay.
We say this plainly because patients deserve to know before they book, not after. The procedures listed here are elective wellness and regenerative treatments. Insurance does not cover them, we do not submit claims for them, and payment is made directly at the time of service.
Call either office for current self-pay pricing. We quote it in conversation rather than publishing a number, because the number depends on the course of treatment that is appropriate for you.
If you are unsure whether something you have been offered is covered, ask us at the time it is offered. Nobody at this practice will be annoyed by the question.
Common questions
Billing, in plain language
If your question is not answered here, call the office. Billing questions are answered by a person, not a form.
The carriers we work with are listed on this page. That said, plan networks change and the same insurance company can offer plans we participate in and plans we do not — so seeing your carrier listed is a good sign rather than a guarantee. Have your card in hand when you call and we will check your specific policy with you before you book.
Call the member services number printed on the back of your insurance card and ask three questions: whether Primary Care 369 LLC is in network for your plan, what your copay or coinsurance is for an office visit with a primary care physician, and how much of your deductible remains for the year. Those three answers tell you almost everything you will owe.
A copay is a flat amount you pay per visit. A deductible is the amount you pay yourself each year before the plan begins paying its share. Coinsurance is the percentage you keep paying after the deductible is met. Which of the three applies to a given visit is set by your policy, not by our office.
You are still welcome. We offer Direct Primary Care for patients who do not carry insurance or who choose not to use a plan — a periodic membership that covers the primary care services defined in your agreement, with extended visits and no claim submitted. A free consultation is available to walk through it before you commit.
No. These are elective wellness and regenerative procedures and they are not covered by insurance. They are self-pay, and we do not submit claims for them. Call the office for current pricing — we quote it directly rather than publishing it, because the right course of treatment differs from patient to patient.
No. Direct Primary Care is not an insurance product and does not cover hospitalization, surgery, emergency care or specialist treatment. Many members carry a high-deductible or catastrophic policy alongside their membership for exactly those events.
Yes, and most patients do. Covered primary care can be billed to your plan while an elective procedure is paid directly. If you hold a DPC membership, labs, imaging, medications, specialists and hospital care sit outside the membership and can still go through your insurance.
Possibly. We collect what is known at the time of service, but the final patient responsibility is determined by your insurer when the claim processes. If a balance remains after your plan pays, you will receive a statement. Compare it against the explanation of benefits your insurer sends you, and call us if the two do not agree.
Telemedicine coverage depends on your plan and can differ from coverage for an in-person visit. Ask about it specifically when you call to verify — including whether your plan applies the same copay to a video visit.
One call settles it.
Tell us your plan and we will tell you where you stand — before you take time off work for an appointment.