General Questions
What is Direct Primary Care?
Under the Direct Primary Care (DPC) model, the patient (you) receives comprehensive primary health care directly from their DPC physician (Dr. King or Dr. Klaucke). The patient pays for this care through a monthly fee, paid directly to Sandpoint Direct Primary Care.
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 money, often amounting 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 – and give compassionate, attentive and timely care at an affordable cost.
What are your prices?
Please find a complete list of our prices HERE.
Do you see nursing home patients?
Nursing home patients are cared for by nursing home staff physicians.
What medical conditions do you care for?
We treat acute and chronic health problems. Acute injuries may be briefly managed with pain medications, however chronic pain management is not a regular part of Sandpoint Direct Primary Care. No pain medications are kept in the clinic.
What if I am hospitalized?
Sandpoint Direct Primary Care coordinates pre-admission and post-discharge consultation with the admitting doctors. Care during hospitalization is provided by hospitalists. Other hospital charges and associated costs will still apply.
Are there any medications not covered in the wholesale generic medication program?
Brand name medications and controlled substances are not covered in the wholesale generic medication program.
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 Sandpoint Direct Primary Care is subject to subpoena or search warrant.
What if I need medical attention while I am away from home?
In the age of telemedicine, many conditions can be diagnosed and treated via a simple conversation by phone or webcam. If appropriate, we will locate the nearest pharmacy and order medication most suited for your circumstance. If you need to go to the hospital or seek other medical attention while away from home, we can advise you on that as well.
May I contact Sandpoint Direct Primary Care after hours? How?
Absolutely, yes! It’s how we do custom healthcare. After normal office hours our members can call Dr. King or Dr. Klaucke’s cell phone.
When do I pay my fees for non-covered labs and procedures?
Charges will be added and applied to your preferred method of payment.
Membership Questions
What does the membership fee cover?
The fee covers excellent primary care through unlimited office visits, annual wellness exams, well-child exams, sports physicals, school physicals, basic office procedures, treatment of acute illness or minor injuries and access to your doctor, all with minimal wait times in the office.
Our patients will also have access to discounted labs and special procedures not included in the membership fees.
Is there a sign up fee to join?
No, we do not require a sign-up fee for a household, family or individual.
Does Sandpoint Direct Primary Care see patients of all ages?
Sandpoint Direct Primary Care currently provides care for patients of all ages including infants, children, adults, and the elderly. We specialize in Family Medicine and are Board Certified by the American Board of Family Medicine.
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, fees will be applied.
Medicare & Insurance Questions
Do I still need insurance?
We recommend that you do have insurance to comply with Federal Law. Sandpoint Direct Primary Care does not replace insurance, and ideally we encourage our patients to carry a high deductible or major medical plan or a plan with a health savings account, thereby ensuring 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.
What if I want to continue my current insurance? Can I still use it?
Not for our services, but Sandpoint Direct Primary Care will be able to order your labs, x-rays and medications at the facilities preferred by your insurance if you would like.
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 Sandpoint Direct Primary Care. 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 Sandpoint Direct Primary Care.
How can I save on insurance costs by being a patient of Sandpoint Direct Primary Care?
Many times patients purchase expensive “Cadillac” plans that require little or no co-pay and that cover all lab costs and prescription costs. However, with Sandpoint Direct Primary Care your monthly fee covers all office visits, and there are no copays. Our patients may find it worthwhile to change from a “Cadillac” health insurance plan to a basic health insurance plan to save money.
Are Sandpoint Direct Primary Care’s monthly fees eligible for HSA or FSA reimbursement?
Yes, our fees are generally reimbursable. This is one smart method of paying for your health care needs with pre-tax dollars.
Direct Primary Care may qualify as reimbursable through your Health Savings Account (HSA) and may also qualify under the Affordable Care Act. Section 10104 of P.L. 111-148 (Patient Protection and Affordable Care Act) states: “The Secretary of Health and Human Services shall permit a qualified health plan to provide coverage through a qualified direct primary care medical home plan that meets criteria established by the Secretary, so long as the qualified health plan meets all requirements that are otherwise applicable and the services covered by the medical home plan are coordinated with the entity offering the qualified health plan.” See your insurance specialist for information.