Pismo Health – FAQ’s

Conventional insurance-based medical practices are becoming unwieldy with more employees and time spent just on billing and collections. Insurance companies dictate the type of care doctors give, and doctors have to see 25+ patients a day to maintain their business. Many times, the cost of billing is more than the fee itself.

Direct primary care allows physicians the freedom to serve patients and practice medicine the way they were trained. No billing means doctors have time to spend with patients, and patients can access the doctor when and where they need to.

Ultimately, direct primary care allows for more than just a better version of what is already there. Doctors are able to redefine the frontlines of care by providing proactive and preventive care that is otherwise unavailable in the traditional system. This leads patients to experience better service while having better health – namely fewer surgeries, specialist visits, hospitalizations, and medications.

Your Content GoeNumerous reports show better care and cost-saving throughout the United States. In North Carolina, DPC saved $1.28 million in health care claims in one year for 2000 patients. Less paperwork for doctors means more time to spend with patients as needed to manage medical conditions. More time means better access which means fewer specialist referrals, hospital admissions, and ER visits. In insurance-based medical clinics, 43% of the day is spent on needless paperwork.

If you feel you need to go to the hospital, please call and discuss with our providers at any time. We can help you decide whether it’s something we can take care of or if the emergency room is necessary. As your private physician, we would like to be involved in your hospital care—whether to speak to the emergency room physician or the in-patient doctor to assist in your care. We are also happy to keep in touch with your families during your stay and help arrange for your care after you return home.

Our providers can order and refer just like any other primary care office. We can send prescriptions to a pharmacy of your choosing and if you need a referral for additional lab work, imaging, or specialist we are happy to send those to a medical facility of your choosing, where you would use your insurance if you have it as you normally would.

In the traditional healthcare setting, most people are accustomed to paying the doctor through insurance on a visit-to-visit basis. The problem is – most primary care is patient-provider dialogue, and it’s hard for insurance companies to know how to reimburse a conversation. This forces doctors to have you come into the office and then charge you every time you want to speak with them or follow up. Recently, Doctors have needed to see upwards of 25+ patients a day just to keep their practices solvent.

In the DPC membership model, doctors are free to dialogue when, where, and how long the patient needs at no extra cost. This significantly increases the level of service and care a patient receives from their doctor. So much so, that in one study patients in a DPC membership model experienced:

  • 40% Less ER Visits
  • 54% reduction in ER costs
  • 24% Less Hospitalizations

*Society of Actuaries, 2020

We have chosen a membership model because it’s affordable to the patient and allows us to take care of our patients (whom we love!) in the best way we know how.

We welcome members whether they have insurance or not. Your membership fee includes all the care you receive in our office—no surprise bills or hidden costs. We also offer cash-pay lab testing and medications at wholesale pricing, and we’ve partnered with trusted specialists and service providers who extend discounted cash-pay rates for any care not provided in our office.

The only change is that I’ve partnered with resources that may save you additional money if you would like to pay cash rather than submit to insurance. However, if you still would like to submit to your insurance, you are welcome to do so. I can provide you with options that allow you to make the right decision based on your situation.

Thanks to recent national policy updates, your Health Savings Account (HSA) now offers even greater flexibility. These changes signify a growing trend in healthcare delivery—making it more accessible, personalized, and supportive of your daily well-being.

NEW INFO:

  1. Telehealth Services – Fully Covered Before Deductibles
    You can now use telehealth for care—even before you’ve met your deductible. That means more access to care without added financial stress.
  2. Direct Primary Care (DPC) – Now HSA-Eligible
    If you or your family use a Direct Primary Care provider, your monthly membership fees will soon qualify for reimbursement through your HSA.
  • Up to $150/month for individuals
  • Up to $300/month for families
    Begins in 2026.

These updates are part of a broader movement to help people access care more affordably and flexibly. It’s healthcare that meets you where you are.

You will need to check with your employer on plan rules and/or with your insurance plan.