You call your doctor’s office on a Tuesday morning because something does not feel right. You get a phone tree, then a scheduler, then the first opening three weeks out. When the visit finally happens it runs twelve minutes, and a good share of that goes to the computer screen.
If that sounds familiar, you have probably come across the phrase direct primary care and wondered what it actually means. Here is a plain-English explanation, written for patients in Wheat Ridge, Arvada, Lakewood, Golden, Edgewater and west Denver who are trying to figure out whether the model makes sense for their family.
The short version
Direct primary care, usually shortened to DPC, is a membership model. You pay your physician’s office a flat monthly fee, and that fee covers your primary care visits directly. There is no insurance claim filed between you and your doctor for those visits, and no co-pay at the front desk.
That one change to how the office gets paid is what makes everything else about the model possible.
Why the payment model changes the medicine, not just the billing
A traditional primary care practice bills insurance for each visit. To stay viable at those reimbursement rates, practices generally have to carry very large patient panels and keep appointment slots short. Nobody in that building wants it that way. It is the math of the structure, not a failure of the people inside it.
A membership practice earns the same amount whether you come in once a year or once a month. That removes the incentive to keep visits brief, which is why DPC practices typically keep panels a fraction of the traditional size and schedule longer appointments. You can read more about the thinking behind how Ridgeview is set up if you want the longer version.
What a membership usually covers
Specifics vary from practice to practice, so always ask. At Ridgeview, membership generally includes:
- Office visits with no co-pay, for as many as your care actually requires
- Direct access to your physician by phone, text or message, rather than through a call center
- Same-day or next-day appointments when something comes up
- Preventive care and annual visits, plus ongoing management of long-term conditions like blood pressure, cholesterol and diabetes
- Visits that are scheduled for real time, so the conversation is not cut short
Our primary care page lists the conditions and visit types most members bring in.
What direct primary care is not
This is the part that causes the most confusion, so it is worth stating plainly.
A DPC membership is not health insurance. It covers the primary care your physician provides in the office. It does not cover hospital stays, surgery, emergency care, specialist visits, imaging centers or prescriptions. Most members keep an insurance plan for those things and use the membership for everyday care. For some households that combination ends up simpler than what they had before, and for others it does not. It depends on your plan and your health needs.
It is also not a way to skip the rest of the medical system. If you need an orthopedic surgeon, a cardiologist or a hospital, a DPC physician still refers you and coordinates that care. The membership changes who you call first, not where complex care happens.
What it costs
Monthly fees vary by practice, by age and by household size. At Ridgeview, the current founding rates are $99 a month for an individual and $179 a month for two adults, with children up to age 26 added at $39 a month each. Standard rates are $129 and $199. Members who reach 100 years old and have an active family member on the account pay $1 a month.
When you are comparing costs, the useful question is not just the monthly fee. It is what you currently spend on co-pays, urgent care visits and the appointments you skipped because getting one was too much trouble.
Who tends to find it a good fit
- People managing one or more ongoing conditions, who benefit from frequent, unhurried contact with the same physician
- Families who want one doctor who knows all of them
- Self-employed people and small business owners on high-deductible plans, who are paying out of pocket for routine care anyway
- Anyone who has been through a stretch of not being able to reach their doctor when it mattered
Who may want to think twice
An honest answer matters more here than a persuasive one. Direct primary care may not be the right move if your current primary care relationship is working well and you rarely have trouble being seen, if a monthly fee on top of your insurance premium would strain the budget, or if nearly all of your care runs through specialists rather than primary care. Some Medicare beneficiaries also have specific considerations worth talking through before joining a membership practice.
Questions worth asking any DPC practice
- How many patients does the physician care for, and what is the cap?
- How do I reach the doctor after hours, and who covers when they are away?
- What is included in the fee, and what is billed separately?
- How are labs, imaging and medications handled?
- Is there a contract or enrollment fee, and how does someone leave if it is not working?
The best way to decide is a conversation
Reading about a care model only gets you so far. Sitting down with the physician who would actually be your doctor tells you much more.
Dr. Christopher Kroner offers a free 30-minute meet and greet at Ridgeview Direct Care in Wheat Ridge. No charge, no obligation, and no pressure to sign anything. Bring your questions, including the skeptical ones.
Book a free meet and greet or call 720-807-9961. We are at 4045 Wadsworth Blvd #300, Wheat Ridge, CO 80033, open Monday through Friday.
This article is general education about a care model, not medical advice. Please see our medical disclaimer.