How It Works
What is Direct Primary Care?
What is Direct Primary Care?
Direct Primary Care is a membership-based approach to primary care designed to strengthen the relationship between you and your physician. Instead of billing insurance for each visit, patients pay a simple membership fee that covers the care provided in our office. This allows us whatever time is needed to tailor our care to each patient’s unique needs, values, and health goals.
The key aspects of Direct Primary Care include:
- All-inclusive Service Fee – Patients pay an affordable service fee that can be broken up into monthly, quarterly, semi-annual, or annual payments. This fee covers any services that we provide in our office. No contracts! Fee schedule
- Smaller Patient Panels – Less patients means more personalized care. This allows relationships to be formed. We offer open door access to doctors, longer appointment times, and essentially no wait times. Appointments are available the same or next day.
- Extended, Unhurried Visits – Appointments are 30-60 minutes to allow for thorough discussions, comprehensive exams, and explanations without feeling rushed. Patients aren’t limited to one health issue but are able to address however many issues they desire at each appointment.
- 24/7 Access & Communication – Patients can reach a board-certified physician day or night for questions or concerns.
- Focus on Prevention & Holistic Care – Care plans emphasize preventive health through lifestyle coaching, not just treating acute symptoms. Weight loss, proper diet, exercise, and sleep quality are very important. We focus on long-term strategies that are evidence based and are well versed in different diets, exercise regimens, medications, and supplements. Each patient is unique, so that requires a plan unique to that individual.
- Strategic Insurance Integration* – Unlike most Direct Primary Care offices, we are credentialed with all major insurance companies and Medicare allowing us to handle insurance requirements such as medication prior authorizations, imaging prior authorizations, and referrals when needed outside of our office (*HMO plans will not allow us to handle these tasks)
Do you take insurance?
We are credentialed with all major insurances and Medicare, but insurance does not cover our service fee. Like other direct primary care clinics, the service fee covers all the care you receive in our office. In fact, we don’t even file claims with insurance companies other than what is required by Medicare. You will receive the same excellent care at Gaston Family Practice regardless of your insurance status! This is why many of our patients have paired our services with a lower cost high-deductible insurance plan or a health share plan, like Sedera. Schedule a time to discuss how these pairings lead to savings. (See more about share plans below.)
Why did we change to this model of Direct Primary Care?
Direct Primary Care removes the hassles and barriers of the traditional high volume, insurance-based practices enabling us to put our focus back on the patient. Instead of having to spend all our time on the red tape and bureaucracy of medicine, we’re given the freedom to do what we studied and trained to do, which is take care of our patients. No more juggling jammed schedules, having 10 minutes to see a patient, worrying about coding, managing a large staff, or trying to figure out whether a procedure or visit is covered. This allows us to get back to the root of why we chose this field in the first place – cultivating real relationships and providing high quality care to positively impact our patients.
How is Gaston Family Practice different from traditional primary care, concierge medicine, and other direct primary care clinics?
Traditional Primary Care: Traditional primary care is what most think of as a typical doctor’s office. In this model, insurance companies act as a middle man between patients and doctors. Insurance companies charge patients and employers top dollar for insurance plans with various copays and deductibles. The insurance company also ultimately decides what the doctor gets paid for their services. The more providers a practice has, the better payment rates the practice can negotiate with the insurance companies. If a practice is small or independent of a hospital or larger private equity group, the insurance companies are not willing to negotiate, leading to lower payments. This has led most physicians to sell out or work for bigger entities to survive, such as hospital systems or private equity owned groups. Bigger entities lead to more overhead costs. Because it requires more money to run a larger business, more patients have to be seen to generate the extra revenue. Traditional practices will have large patient populations of 2,000-4,000 patients per provider. In most practices, it is hard to schedule appointments, ask questions due to high call and portal volumes, and communicate with in general. Return calls, return messages, and interpretation of lab results are typically delayed days to weeks due to high volumes. Most practices divert any acute issues to urgent cares and emergency departments due to busy schedules. No longer are you able to see your PCP (primary care provider) when problems arise in most traditional practices. Shorter appointments and long waits to get an appointment are common. The evolution of traditional clinics has led to many physicians burning out, which causes a lot of turnover and loss of continuity of care. See comparison chart below.
Concierge Medicine: Concierge practices charge an annual retainer or membership fee, often $2,000 – $10,000+ annually per patient. The provider panels (number of patients a physician cares for) are much smaller, which allows for more individualized and prompt care. They usually care for 300-500 patients rather than 2,000-4,000 patients. Care is excellent, but you pay for it. The premium only covers office membership and enhanced access, but not any actual care costs. The office still bills the insurance for the services provided and the patient is still responsible for all deductibles and copays as they would with any other Traditional Primary Care clinic. See comparison chart below.
Direct Primary Care (DPC): DPC practices cut out insurance companies by allowing patients to work directly with their physician to receive medical services. There is a monthly, quarterly, or annual service charge and in most cases the service charge covers unlimited primary care visits and basic office services. DPC physicians have smaller patient panels of around 500-1000 patients and the clinics usually offer same-day appointments, extended visits, and excellent access/communication. Most DPC clinics are able to do labs, procedures, and anything else you find in a traditional primary care clinic. DPC is not without its limitations though, in exchange for lower monthly membership fees many DPCs charge additional fees for labs and procedures which can create confusion among its members. Also, DPC’s are not usually credentialed with insurance companies so they are frequently unable to arrange for insurance covered services outside of their clinic like imaging studies, referrals to specialists, and medication prior authorizations though DPC clinics can help patients find low-cost advanced imaging, lower cost options for specialist care, and other services. See comparison chart below.
Gaston Family Practice: At our core, we are a Direct Primary Care practice, but we go above and beyond by simplifying our pricing and credentialing with insurance companies.
-Our service fee is all inclusive, there are no added fees for in-office testing, routine labs drawn on-site, in-office procedures, or after-hours correspondence. Your monthly fee simply covers all the care provided in our office.
-Credentialing is the process where an insurance reviews and formally recognizes a provider’s qualifications and being credentialed allows us to interact with insurance companies in ways other direct primary care providers cannot. It allows us work with your insurance company when you need to use your insurance for care you receive outside of our office like prior authorization for imaging services, medication approvals, and schedule referrals. However, even though we maintain our credentialing we do not file claims in our office (other than what is required by Medicare). This is the best of both worlds as our patients are not required to pay copays or deductibles, but we are still able to take a greater role in coordinating the care our patients receive outside of our office. See comparison chart below.
| Traditional Primary Care | Personalized Medicine | |
|---|---|---|
| Panel Size | 2500-4000 | 300-800 |
| Patients per day | 25-35 | 8-15 |
| Average time with patient | 7-15 minutes | 30 minutes |
| Availability | Business hours/answering service | 24/7/365 |
Does membership replace my insurance?
The simple answer is no. While it’s true you don’t need insurance to be a patient at Gaston Family Practice, we still recommend some form of catastrophic coverage for any possible surgeries, hospital stays, or care outside of our practice. Some patients have traditional insurance through work. A high deductible plan with an HSA/HRA is a perfect pairing for our office. Some patients qualify for a cheaper insurance plan through the healthcare marketplace with higher copays and deductibles, which is a good pairing with our office. A health share plan is a great option for those that can’t get insurance for a reasonable price. These plans are typically much cheaper and provide better catastrophic coverage than traditional insurance.
What is a Share Plan?
Health share plans are a low-cost alternative to traditional health insurance. While not technically insurance, health share plans allow members to protect themselves against large or unexpected medical costs. In many cases, a good health share plan can be as little as 50% of the cost of unsubsidized insurance. But like insurance plans, most health share companies let their members choose from a range of monthly costs and coverage options. With health sharing plans, members make a monthly contribution towards a shared “pool” of money. When a member incurs a qualified medical expense, they can be reimbursed from this pool. In other words, health share plans make it possible to share the cost of medical expenses with other members of your share plan, similar to how traditional insurance technically works. Health share plans are not required to share medical costs of pre-existing conditions or preventive care. However, most plans make sharing available for pre-existing conditions after a predetermined waiting period of 1 or 2 years. Pre-existing conditions that would be problematic would be a medical condition that you could be hospitalized for. Some plans also cover preventive care, such as colonoscopy, mammograms, and pediatric immunizations. Each health share plan is different, so make sure you research the details.
We believe in health share plans and are members of the Sedera health share plan ourselves. Dr. Wysong will be the first to tell you that he has saved $24,000.00 in 1 year after changing from traditional insurance to Sedera health share plan paired with Gaston Family Practice!
What ages do you see?
We are experienced, board-certified family physicians and we provide healthcare to ALL ages, including newborn care!
We are experienced, board-certified family physicians and we provide healthcare to ALL ages, including newborn care!
How much does this cost?
Please see our fee schedule for monthly costs.
Please see our fee schedule for monthly costs.
What does my monthly fee cover?
The monthly service fee covers everything the doctors do in the office including unlimited visits for well care, chronic illness care, sick care, and even procedures (like sutures, joint injection, skin biopsies, etc.). If you need a physical, we will see you. Laceration? Let’s get you sewn up! Need a skin lesion removed? We’ll get it taken off or frozen. Ingrown toenail? Let’s get that removed. Sick? We are going to see you today and not put you off for days/weeks or send you to urgent care. In addition, your membership covers after-hours access to one of our doctors for when you need advice on nights or weekends and even covers routine labs and some vaccinations. Your dependents get 6 appointments* each per year. You can even use your membership to get a visit for an out-of-town guest for $50. (*if your dependent exceeds 6 visits in a year, there will be a $50 charge for each additional visit)
The monthly service fee covers everything the doctors do in the office including unlimited visits for well care, chronic illness care, sick care, and even procedures (like sutures, joint injection, skin biopsies, etc.). If you need a physical, we will see you. Laceration? Let’s get you sewn up! Need a skin lesion removed? We’ll get it taken off or frozen. Ingrown toenail? Let’s get that removed. Sick? We are going to see you today and not put you off for days/weeks or send you to urgent care. In addition, your membership covers after-hours access to one of our doctors for when you need advice on nights or weekends and even covers routine labs and some vaccinations. Your dependents get 6 appointments* each per year. You can even use your membership to get a visit for an out-of-town guest for $50. (*if your dependent exceeds 6 visits in a year, there will be a $50 charge for each additional visit)
How is Gaston Family Practice different for patients with Medicare?
We are proud to care for our Medicare patients. This population often has more complex medical needs, and we value the time and attention it takes to provide thoughtful, comprehensive care.
Our physicians are credentialed with Medicare so we can file claims for all covered services including office visits, lab work, referrals, imaging, and medical authorizations. Medicare requires us to submit claims for these services under the mandatory claim submission rule (Section 1842(b)(18) of the Social Security Act).
In addition to the care Medicare covers, we offer a monthly membership that gives our patients access to services that are not reimbursed by Medicare, such as extended appointment times, same-day/next day visits, 24/7 direct communication with your physician, and common minor procedures that Medicare does not consider medically necessary (such as benign skin lesion removal, routine ear cleaning, non-covered toenail care, etc.)
This monthly fee does not replace your Medicare coverage, nor does it pay for any service that Medicare reimburses. Instead, it enhances your access to additional benefits that allow us to deliver more timely, personalized care.
As a Medicare patient, you will continue to receive the same level of attention and commitment as all our members, with experienced physicians who take the time to listen, review your medications, manage chronic conditions, and help you understand your options.
Do you take Medicaid?
We are credentialed with Medicaid so we can provide the same high level of service to our Medicaid patients, but we do not bill Medicaid for any services we perform.
We are credentialed with Medicaid so we can provide the same high level of service to our Medicaid patients, but we do not bill Medicaid for any services we perform.
What if I need a prior authorization or referral?
We are credentialed with Medicare, Medicaid, and all major insurers allowing us to complete prior authorizations and referrals in most circumstances. We would ask our patients to beware of “HMO” insurance plans. “HMO” plans only allow a small subset of participating doctors to perform tasks, such as prior authorizations and setup imaging. This also limits what specialists you can see and where you go for imaging and procedures. In the case of an uninsured patient, we will work to find you the most cost-effective options for medicines, imaging, and specialist referral.
We are credentialed with Medicare, Medicaid, and all major insurers allowing us to complete prior authorizations and referrals in most circumstances. We would ask our patients to beware of “HMO” insurance plans. “HMO” plans only allow a small subset of participating doctors to perform tasks, such as prior authorizations and setup imaging. This also limits what specialists you can see and where you go for imaging and procedures. In the case of an uninsured patient, we will work to find you the most cost-effective options for medicines, imaging, and specialist referral.
What hospital do I have to go to?
Any hospital you want! While we are credentialed with CaroMont, our local hospital, we are completely independent and have no obligation to refer to any particular hospital or specialist. We will send you to the hospital or specialist that best suits your needs.
Any hospital you want! While we are credentialed with CaroMont, our local hospital, we are completely independent and have no obligation to refer to any particular hospital or specialist. We will send you to the hospital or specialist that best suits your needs.
Can I use my HSA, FSA, or HRA?
As of 1/1/2026, Direct Primary Care is considered an eligible medical expense and patients are now free to use their HSA, FSA, or HSA dollars to pay for this service.
As of 1/1/2026, Direct Primary Care is considered an eligible medical expense and patients are now free to use their HSA, FSA, or HSA dollars to pay for this service.
So how can Gaston Family Practice help businesses?
We are glad you asked! Pairing a better insurance option with a Direct Primary Care, such as Gaston Family Practice, can save a business up to 40% on their costs for health coverage. Businesses with 20 or more employees can level-fund or self-fund their health plans and use Gaston Family practice for all their outpatient needs. Less than 20 employees can use a health share plan for their catastrophic coverage and Gaston Family practice for all their outpatient needs. We have learned a lot about the business of medicine and providing coverage for employees, especially through owning and managing our own business. We don’t claim to be experts, though. We have found some experts that we trust with forward thinking that pairs well with one of our practice goals, which is to provide excellent healthcare that is cost effective. Kimmel Benefits is a company that has helped our business and other businesses make very successful changes in their health coverage. Go to their website for more information, https://kimmelbenefitsplus.com or talk with your benefits manager.