FAQ

How do I qualify for PMC services?

Most insurance companies cover in home primary care when a patient is considered homebound.

To be homebound, the patient needs to have significant difficulty getting out of the home for basic trips. Patient does not need to be completely unable to leave the home, but trips to the grocery store (for example) are difficult/taxing.

There are many ways to meet these criteria. Patients with developmental delays who have difficulty getting into a vehicle and become distressed in such situations. Patients with mental health diagnoses that limit their ability to leave the home due to distress of activity or anxiety of activity. Patients with advanced health conditions that prevent much activity beyond moving around the home. Patients with memory loss who are unable to independently leave the home safely. Patients who require assistive devices to move around safely.

If a person needs assistance in leaving the home, it is likely they will qualify.

Examples of diagnoses that are commonly present (but need to be at least moderate in their severity):

Dementia/Alzheimers, Autism, Agoraphobia, COPD, Heart Failure, Cerebral Palsy, Diabetes, Schizophrenia, Depression, Chronic Pain, Multiple Sclerosis, ALS, Quadriplegia/Paraplegia.

How do the visits work?

Visits are scheduled ahead of time at a given time. There is a time window that will be given around the scheduled time around which the provider will arrive. Precise timing is not possible due to traffic, construction, duration of previous visits, etc.

Visits are held in the house where it is comfortable for the patient. Vital signs will be obtained, topics important to patient and provider will be discussed. Any prescription refills, new prescriptions, labs, imaging will be ordered during visit. Next visit will be scheduled prior to leaving.

How does direct primary care work?

Direct primary care is at its most basic a different way of paying for your healthcare.

With PMC, it does not change the quality or amount of care you receive. Visit duration and frequency are determined by your healthcare needs.

Under direct primary care with PMC, you will pay a one time onboarding fee, an annual fee, and a monthly fee. These costs cover all visits with your PMC provider. Your visits will not be billed. No matter how many visits you have, your costs will not change.

Keep in mind that only our visits and procedures done in the home are covered by this method. For example, if an injection is needed-- the medication will be ordered to your pharmacy and the provider will administer the medication as ordered. You would pay at the pharmacy but any administration fee would be included in your monthly fee. Also, if an xray or labs or other services that cannot be accomplished in the home are ordered, those services will be billed by the entities that perform them.

It is still recommended that you carry health insurance. Direct primary care can normalize your monthly costs (no more surprises due to increased number of visits in a given time period) and likely even decrease your costs as co-pays do not apply and refusal of payment by the insurance company is not a concern.

What if the potential patient is a friend/family member?

Many persons that would benefit from PMC services are unable to make those decisions themselves or access the service without assistance.

At times there are guardians or POAs involved, but this is not always the case.

We encourage you to work with the person needing the care and contact us to discuss the situation. There may be additional documents or approvals required before we can initiate care, but there may not be.

We strive to maintain autonomy of each person for as long as they are able. If the person is unable to make decisions on their own, ensuring that the correct person/persons are involved in those decisions is not only important for legal purposes but for the safety of the person receiving the care.

I'm embarrassed of my house. Can visits be done anywhere else?

We have seen the entire range of living situations. We are not in your home to investigate the state of your home. We are not bothered by clutter or mess. We only ask that the location be safe for both you and us.

The guidelines do state that the person being seen should be seen in their permanent residence which is generally considered the address where they receive mail.

We also understand that there are times when a person does not have a permanent residence. This should not deter anyone from receiving the care that they need. We will work with you to ensure timely visits in safe locations.

What about my pets?

We love interacting with and meeting these important family members.

We only ask that pets that are clingy or possessive, be put in another room or sufficiently distracted during the visit. This is to ensure the safety of everyone. We have seen more than a few patients that have pets that become aggressively protective when the person is approached or vital signs are being obtained or other necessary actions are being taken. These events increase the chance of injury to or by any being in that situation and avoiding this is much better than dealing with it after it occurs.

What if there are other people in the home?

Often, there are others present for visits whether by necessity or preference. We do like to know who will be involved in the visit prior to arrival so there are no surprises.

At times, there are others in the home that are not involved in the visit. The person being seen will ultimately have the say over how a visit is conducted in those situations. Sometimes, the other person can be asked to leave the home for the duration of the visit (for example, a chore provider) if preferred by the patient. Other times, this cannot be accomplished (especially when the other persons also live at the residence).

All visits are conducted in a manner to provide the amount of confidentiality required by law and requested by the patient. Measures can be taken to improve this (closing doors, writing down questions/answers instead of talking, and so forth), but if the patient is not comfortable with the situation, the visit can be rescheduled. We may not be able to guarantee when the rescheduled visit will occur but we will never force a patient to have a visit when they are not comfortable doing so.

Can I still see my regular doctor?

PMC is a primary care service. We are not a specialist or supplemental service. We take over for your regular doctor/PCP. There are rare situations where the patient is able to return to their previous primary care provider after a time. We do work at getting records from your previous primary care provider to be able to provide as seamless care as possible.

Can I still see my specialist?

As PMC is a primary care service, we do encourage you to continue with seeing your specialists. There are times when this is not possible either to continue with a specialist or to initiate care with a a specialist. We will continue to provide the best care possible throughout the time that you are with our service.