Question 1

What is DPC?

Accepted Answer

DPC or Direct Primary Care is a fast growing membership-based health care model.With over 2000 successful practices (up from 500 in 2015) across the country, DPCworks outside of the insurance industry and charges an affordable Membership Fee fora variety of primary care services.

Question 2

I usually only see the doctor once or twice a year. Why can't I just pay cash when a visit is needed?

Accepted Answer

Sunnyside model works to keep the costs down for everyone because everyone is paying every month. This allows the total membership to stay relatively low, which allows for the accessibility, long appointments, and minimal waiting. Cash fee-for-service results in volume-driven reimbursement, just like traditional practice. When revenue is no longer dependent on high volume, the volume stays low and access remains high. Simply put, the DPC model just doesn't work that way.

Question 3

I have Medicare. How can my Membership actually save me money?

Accepted Answer

Many Medicare patients save each month by becoming members of a DPC practice particularly if they are healthy and do not typically have to see specialists. Consider the following. Medicare Part B is voluntary, not required. Only Part A is required. You can keep the amount you pay each month for your supplement, see me for most of your healthcare needs, and if you need to see a specialist or have diagnostic studies, you just pay the 20% out of pocket. Considering most supplements cost $2400 to $3600 per year and my plan is 1500 a year you will likely come out ahead, while having the benefits of a DPC practice like accessibility and minimal wait times. Part A covers you if you are hospitalized. For those who feel better having a supplement, you can choose a Plan F high deductible supplement. The premium is often less than $100 per month, and you pay the first $2160 as a deductible if you have to use it. Have a good year and you saved more the difference between your deductible and the $1500 a year membership fee. Have a bad year and you just pay the $2160 that you would have paid for the higher premium supplement anyway. You have nothing to lose; only savings to be gained.

Question 4

I have insurance. Why should I pay you a Monthly Membership Fee?

Accepted Answer

As more and more people are discovering each year, having insurance and having access to care are completely different. As deductibles get higher and benefits diminish people are getting less and less with their expensive insurnace plans. Insurance is not health care! With Sunnyside are paying for the personalized service that is not available in fee-for-service practices, at a fraction of the cost of concierge practices.

Question 5

What happens when I need labs or x-rays, or if I need to go to an ER, specialist or hospital?

Accepted Answer

Since Sunnyside is not an insurance plan, we still recommend you carry health insurance that covers you in case of an emergency or high-cost health event. Whenever you need labs, x-rays, expensive medications, specialist or hospital visit, you are welcome to use your insurance. If you don't have insurance or have a high deductible which you don't expect to meet, I can direct you toward more affordable services. For example, we have negotiated with local labs and imaging faciliites to find the most affordable self pay prices for these services (since paying out of pocket is often significantly more affordable than going through insurance). Even outside the office, Sunnyside will continue to serve as your advocate for your health care needs.

Question 6

What if I have a flexible spending account (FSA) or a healthcare spending account (HSA)? Can I use it to pay the monthly fee?

Accepted Answer

The tax laws regarding the use of FSA and HSA cards are evolving. You can't use an HSA to pay insurance premiums; prior to the Affordable Care Act, the monthly fee in a DPC practice was viewed in a similar way as an insurance premium. The ACA specified that DPC docs are not insurance companies, but the tax laws are evolving more slowly. So you should consult with your accountant before using an FSA or HSA card to pay the monthly fee as the tax laws surrounding their use are expected to change in the near future. We will provide a detailed receipt that outlines the services rendered for the monthly fee in order to facilitate the use of FSA/HSA funds; however it is your responsibility to make sure you are using these tax-advantaged accounts appropriately.

Question 7

If I already have a comprehensive insurance plan (PPO/HMO), what happens if I need to get prior approval for medications, x-rays, or specialty services?

Accepted Answer

I am happy to get prior approval for any medications or diagnostic studies your insurance requires. However, I am not an in-network physician on any insurance plans, so if your plan is an HMO that requires authorizations to be done only by in-network physicians, I would not be able to do this and you would need to see the primary care doctor to whom you were assigned, and pay the office visit copay, in order to get an authorization. I am not aware that any insurance plans require that medications be prescribed by an in-network physician in order to cover them, but if you have an HMO you should be sure to verify that. Plan requirements change every year.

Question 8

What is Spruce?

Accepted Answer

Spruce is a HIPAA-compliant user-friendly app that provides a quick and secure way for you to connect with your physician from any device. You can schedule an appointment, text symptoms or photos, or send a question to your doctor. Sunnyside provides this service to you as part of your Monthly Membership Fee.

Question 9

How can Sunnyside help my small business?

Accepted Answer

Adding Sunnyside to your benefits package could save up to 30% of your total healthcare costs, while saving your employees out-of-pocket expenses because Sunnyside does not charge copays or deductibles. This will help your employees stay happy, healthy, and productive.

Question 10

So, how do I sign up?

Accepted Answer

Joining is easy!  At the next business day we will contact you about scheudling your enrollment appointment. We look forward to having you join our family!

Question 11

Is Sunnyside the same company as LevMed Health?

Accepted Answer

Yes! With a new location and a new provider we thought it would be a good time torebrand. Dr. Levine is still the owner of Sunnyside but we wanted to find a name thatbetter incorporates Dr. Bugg, future physicians and our mission…Sunnyside. Plus, Dr.Levine has potential plans of opening a new practice in the Sunnyside neighborhood of Denver.

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