Frequently Asked Questions

STILL HAVE QUESTIONS?

Take a moment to explore the benefits of Dr. Hoffman’s Direct Primary Care practice so you can decide whether or not it is the right choice for you.

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 24/7/365 access to your doctor, all with minimal wait times in the office.

Our patients will also have access to discounted labs, prescriptions, and radiology.

Is my membership fee at Vanguard Direct Family Medicine tax-deductible?

Unfortunately, it is not. Your membership fee is not yet defined as a “medical expense” in most states and therefore is not tax deductible. The American Academy of Private Physicians, however, is lobbying hard to win rightful deductibility for these expenses. We advise that you discuss this further with your tax preparer or accountant. Anything we order such as labs, radiology, and medications can be applied to HSA, HRA, FSA, or out of network deductible.

What costs are involved in becoming a patient?

There is a one lifetime signup fee of $50. A monthly membership fee is all that is required. This will cover costs of providing care to you and your family throughout the year. We will not charge or collect any copayments/coinsurance/deductibles for visits. When you come for a visit, it’s okay to leave your wallet at home. You’re covered!

Does Vanguard Direct Family Medicine see patients of all ages?

Vanguard Family Medicine currently provides direct primary care for patients of all ages

How do I join if the practice is full?

In order to provide the highest possible level of personalized, quality care to patients who choose our practice, we must limit membership.

As a result, once our practice membership is full, a waiting list will be established. As openings become available, you will be contacted by a member of our team regarding membership.

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 you choose to rejoin, fees will be applied.

Do you really make house calls?

Absolutely. If in my opinion the situation warrants a house call, I will come to you at no extra charge.

Pricing

Radiology Pricing

Description	Patient Price
Chest x-ray 2 view	$35.20
X-ray exam of wrist 2 view	$42.90
X-ray exam of hand 2 view	$37.40
X-ray exam of knee 3	$44.00
X-ray exam of neck	$34.10
Ct abdomen w/o dye	$185.90
Ct abd & pelvis w/o contrast	$250.80
Us exam abdomen complete	$152.90
Us exam pelvic complete	$137.50
Mammogram	$99

Prescription Pricing

Our office and all providers participate in the Tennessee Drug Monitoring Program. Our providers do not prescribe narcotics except for very specified conditions and short term only.

Medication prices all reflect an additional 10% markup for supplies/administrative costs. Prices subject to change, pending availablity.

No controlled substances or pain medications will be on site.

Description	Patient Price
Acetaminophen (tylenol) for pain/fever #30	$0.18
Ibuprofen 600mg (equal to 3 advil) for pain/fever #30	$1.35
Fluticasone (Flonase) 120 sprays (1 month) for allergies	$4.73
Loratadine (claritin) 10mg #30 (1 month) for allergies	$1.20
Amoxicillin 500mg #20 (1 week) antibiotic	$2.82
z-pack antibiotic (5 days)	$1.47
Fluconazole (diflucan) 1 dose for yeast	$1.25
Metformin 500mg #30 (1 month) for diabetes	$0.72
Lisinopril 20mg #30 (1 month) for blood pressure	$0.66
Losartan 100mg #30 (1 month) for blood pressure	$1.56
Atorvastatin (Lipitor) #30 (1 month) for cholesterol	$2.70
Citalopram 20mg #30 (1 month) for depression	$0.69
Famotidine (Pepcid) 20mg #30 (1 month)	$0.99
Promethazine (Phenergan) for nausea #12	$0.62

Labs Pricing

Description	Patient Price
Basic metabolic panel	$2.31
Complete Metabolic panel	$2.97
Glucose	$1.76
Complete blood count	$2.53
Lipid panel	$3.52
Hemoglobin A1C	$3.52
Microalbumin/creatinine ratio	$4.95
TSH	$2.97
Vitamin D	$14.30
Vitamin B12	$4.73
PSA	$4.18
Gonorrhea and Chlamydia	$24.20

ALL PRICING IS APPROXIMATE AND SUBJECT TO CHANGE

No controlled substances or pain medications will be on site.

Give us a call to get discount pricing. We can get almost any medication and we have access to brand medicines as well.

Included Member Services

Same day and next day scheduling
House Calls
Extended Office Visits
Annual Wellness Exams
EKG
Venipuncture
Pulse Oximetry
Peak Flows
Nebulizer Treatments
Joint Injections
Small Lesion/Wart Removal
PAP Smear ($27.50-$55 pathology fee may apply)
Suturing Simple Lacerations
Trigger Point Injections
ADHD Treatment
Ear Irrigation

General Questions

What is Direct Primary Care?

Direct Primary Care is a nation-wide movement of Primary Care doctors who have disembarked from the insurance companies and their assembly-line model of medicine in favor of re-establishing the patient-doctor relationship. It is a form of concierge medicine that is designed to be affordable for the masses. We operate on a monthly membership fee, much like a gym, which allows patients to receive unlimited office visits and what we call technology visits (email, cell phone, text messages, etc.).

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.

Is this like MDVIP?

This is not like MDVIP. MDVIP doctors still contract with insurance companies, and as a result are required to collect a copayment, coinsurance, deductibles, and any non-covered service amounts as required by the health insurance contract, plus the retainer fee, and this is exactly why we chose not to go that route.

MDVIP doctors also have a much higher retainer fee, $1650 per individual. MDVIP also requires an up-front payment in order to join their practices. We are happy to offer a monthly payment plan.

Lastly, MDVIP offices are unable to sell wholesale medications and lab services. We are able to do all of this because we don’t take insurance.

Why is a Direct Primary Care practice a better option?

Many patients today and in the near future will end up having high deductible plans, where the insurance won’t cover the first $2,000-$5,000 that they spend anyway, but with our membership model, they can maximize the amount of healthcare they get and minimize their cost. In the new model of care, we work with our patients directly through a monthly membership so they get unlimited office visits and what we call technology visits. They also don’t have co-pays for anything in our office. Any procedures we can do in our office like: EKG, PFT’s, biopsies, cryosurgery, joint injections, etc., are included free of charge.

In addition, we will run our own pharmacy out of the office, so we can get medications at wholesale pricing. We can also get labs and radiology at wholesale pricing, which will be a substantial savings for the patient. So in the long run, we actually end up saving our patients more than the membership costs.

Will I still benefit from a Direct Primary Care practice even if I don’t require frequent medical attention?

We love that question and we hear it often! Everyone benefits from medical care personalized directly for them. Our practice is committed to preventative health maintenance which is a long-term investment in you! Physicals, i.e., preventative health visits, are not just routine; they are opportunities for early disease detection, much like a state inspection for your car.

Every visit, regardless of the reason, will give us the opportunity to get to know you better and to build a long-standing relationship over time. As a result, individual care plans can be developed that are tailored to the individual needs of each patient. Traditional medical practices, which are insurance-driven, find it difficult to forge this relationship effectively like we are fortunate to do.

How will I know if the doctor in Vanguard Direct Family Medicine is right for me?

Since you are on our website, you are on the right track already! If you like what you have read so far, we invite you to call us at the office so that we can personally answer your questions. Also, please check out our Facebook page. There are a lot of great topics that may interest you and help aid you in your decision making.

Do you do immunizations?

We have tetanus, TDAP, and can order travel vaccines at wholesale cost. Other immunizations are done at the local pharmacy or the Rutherford County Health Department. We encourage proper immunizations of our patients of all ages and we are open to discussion of questions or concerns.

We will help you with the Centers for Disease Controls most up to date recommendations. We do not offer other immunizations in our office because we have no way to save you money on them. Pharmacies are already good at this; they are usually sold at cost.

What are your prices?

Please find a complete list of our prices here.

Can you help with the costs of prescriptions? What about labs?

Because we are an insurance free practice, we have a unique situation where we can directly purchase medications at wholesale cost from the manufacturer. We will pass these savings directly on to you. In addition, we have a contract with a lab to purchase lab testing at wholesale prices with these savings passed directly on to you.

Finally, we have a direct relationship for imaging studies, such as X-rays, CT’s, and MRI’s, all at a substantial discount. Much like a membership at Sam’s Club, membership in our practice gets you these cost-saving discounts on medications, lab tests, and imaging studies.

What medical conditions do you care for?

We treat acute and chronic health problems.

What happens if I need to go to the hospital or see a specialist?

At present, our patients, if hospitalized, are seen by the hospitalist. Perhaps down the road we may consider offering hospital care, but for now, we are relying on the hospitalist. Our commitment is to help you avoid being hospitalized by early detection of disease and/or subtle signs that an existing disease state is worsening. Having a non-pressured doctor who is always available to assist in your health care is key to helping to reduce hospital stays.

We will still refer patients to specialists as necessary.

Does Dr. Hoffman take care of her patients in the hospital?
She will often visit her patients when they are in the hospital. Please call us, if you desire this. Dr. Hoffman will discuss your care and provide any needed charts or records to the hospitalist doctor to facilitate the best possible care. Upon discharge, she will readily follow up with you and your family to try and keep you on the road to recovery and minimize confusion after discharge.

Are my medical records ever shared with insurance carriers, pharmaceutical companies, or government agencies?

Absolutely not! 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 Vanguard Direct Family Medicine is subject to subpoena or search warrant.

What if I need medical attention while I’m away from home?

Contact us! We can determine the most effective means of communication to determine the best approach to handle your specific situation. Again, we can connect via email, cell phone, text message, Facebook, etc. We’ll help you find the nearest pharmacy and prescribe the medications you need.

In addition, as a patient of Vanguard Direct Family Medicine, you may consult with other concierge physicians across the country who participate in the National Care Network for Direct Primary Care.

May I contact Vanguard Direct Family Medicine after hours? How?

Of course you can! We are always here and always available. We understand that illness and injury do not always occur during office hours; therefore, you may call us at any time. You can contact us via email, cell phone, text message, Facebook, etc. We want to be accessible to you!

What if I need care on the weekends?

If you have an urgent after-hours concern that you believe cannot wait for routine business hours, Dr. Hoffman will be available by phone to assist you. While she will come into the office on the weekend for an urgent need, she finds that the need is very rare. She is not available for routine matters that can wait until normal business hours on the weekends. She is dedicated to your care and to a healthy, cultivated physician-patient relationship.

So, no matter when I need you- you’re available?

No, not exactly. Dr. Hoffman is a primary care physician. This means she can address most of your problems, most of the time. We are also a low cost medical office. We are cultivating something sustainable, enjoyable, and transformative. This requires a partnership with our patients. In this age of digital access and instant responses, we are striving for sustainability. We ask our patients to utilize our services, in person or electronically, when they need us. We also ask that if matters can wait until waking hours they do.

What if I’m having a medical emergency?

As is customary with any true medical emergency, call 911 or go to the nearest emergency room. If you are not having a medical emergency, but feel you need prompt medical care, please call Vanguard Direct Family Medicine.

What is not available at Vanguard Direct Family Medicine?

The physician at Vanguard does not manage chronic pain and does not prescribe chronic pain medications. We do not have or keep any pain medications in the office. These medications are heavily regulated, need substantial monitoring, have a high rate of diversion, and for most patients are detrimental to their long-term health and well-being.

We are not a fee-for-service same day clinic. We work hard to meet our members needs as they arise but do not offer ‘same-day’ or ‘one time’ visits for non-members. We believe in long-term primary care relationships. It’s what we do best.

We do not offer pregnancy care, DOT physicals, and we are not the admitting doctor when our patients need hospitalization.

When do I pay my fees non-covered labs and procedures?

Charges will be added and applied to your preferred method of payment.

Medicare & Insurance Questions

Does Vanguard Direct Family Medicine accept health insurance?

Insurance free means exactly what it says: we do not accept health insurance.

The most pivotal and difficult decision that we have made is to cut all ties with insurance companies. Our “care” philosophy is absolutely vital to the health and well-being of our patients, and we are committed to forging a direct personal relationship between you and your doctor. This allows us the freedom to see patients on our terms without being tied to the rhetoric and rules of insurance companies who are not at all interested in your well-being.

As a patient of Vanguard Direct Family Medicine, will I still need insurance?

Yes. Although health insurance is NOT necessary for membership, we recommend that you do have insurance to comply with Federal Law. We do encourage patients to maintain some level of health insurance to help cover the costs of medical care that you receive from medical providers and facilities outside of our practice. We advise patients to maintain insurance coverage for medical catastrophes such as cancer, trauma, and unexpected surgery. These events are extremely expensive and there’s no way around it. Patients who need regular subspecialty care (say if you have multiple sclerosis or rheumatoid arthritis) need reasonable insurance coverage for the specialists they see along with specialty drugs they may need.

Insurance will help cover costs associated with, but not limited to, prescription medications, labs, imaging studies (X-rays, CT scans, MRI’s, etc.), specialist consultations, hospitalizations, and surgeries.

Vanguard Direct Family Medicine 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.

We understand that many hardworking people simply cannot afford insurance. We encourage you to consider consulting with an insurance agent (we can recommend some, if needed) who understands direct primary care. Other patients choose to work with cost sharing programs like Liberty Direct or Medishare to arrange some type of financial coverage in the event of a medical catastrophe.

There are other options currently in process. In two states patients can purchase ACA compliant high-deductible plans that are somewhat designed with direct primary care in mind. Senate Bill 1989, presently in the works, would allow for HSA dollars to be used for the monthly direct care fee. The bottom line is, in most situations, insurance or no insurance, direct primary care clinics can save people time, money, and headaches with our low-cost, transparent care model.

What if I want to continue my current insurance? Can I use it?

No. We are an insurance-free medical practice which means that we do not accept insurance. This does NOT mean, however, that patients with insurance cannot become members in our practice.

Because we do not contract with any insurance companies, we do advise you to review your insurance contract regarding “Out-of-Network” benefits for possible reimbursement of services you receive from us.

How does this work with ObamaCare?

As the Affordable Care Act (ACA) was being drawn up, several doctors worked very diligently to insert into the health reform bill a clause that allows for Direct Primary Care practices like ours to be a legal option under the health reform bill. Once the health exchanges open in October, many people will understand that a Direct Primary Care practice is an approved option.

In short, the best option for many patients will be an “exchange qualified” major medical type plan combined with a Direct Primary Care provider like our practice. This combination will save the maximum amount of money, while also allowing for a maximum amount of health care for patients.

The Direct Primary Care practices have the ability to decrease the cost of insurance by 30-50%, thus eliminating the need for ObamaCare-style regulation because we can make health insurance affordable again.

If I have Medicare, can I join as a patient?

Yes. You will need to sign a waiver every two years declaring that neither you nor your doctor will directly bill Medicare for our services. Even though Medicare will not pay us for any services you receive in our practice, your Medicare benefits will otherwise remain unchanged and can continue to be used for all other medical care received outside of our practice. Medicare will still cover any laboratory testing, imaging, medications, or hospitalizations prescribed by our offices.

What if I don’t have insurance?

You are welcome to become a member too.

How can I save on insurance costs by being a patient of Vanguard Direct Family Medicine?

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 Vanguard Direct Family Medicine your monthly fee covers all office visits, basic labs 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 Vanguard Direct Family Medicine’s monthly fees eligible for HSA or FSA reimbursement?

You may want to check with your human resources department regarding the use of Health Savings Accounts (HSA’s) and Flexible Spending Accounts (FSA’s) as possible payment options for your annual membership. If you are unable to use these funds to pay for the annual membership fee directly, there is a good chance that you can still use your HSA/FSA as reimbursement for certain services provided through our office- such as billed labs, imaging or medication fees.

If we haven’t fully answered all of your questions, please contact us via phone or email so we can further assist you.

Where should I look for affordable insurance?

Here are some links for affordable insurance options. Vanguard Direct Family Medicine does not endorse these companies but they are helpful resources for individual research for insurance options.

Catastrophic insurance

GET IN TOUCH

For your complete care, you have full access to us.