Both Concierge Pediatrics and Direct Primary Care are healthcare models that prioritize personalized care, direct access to physicians, and preventative healthcare. Despite the nomenclature, they are both similar in the care provided. They both operate on a subscription-based system. In this model, pediatricians offer direct medical care to their patients without the involvement of insurance companies or third-party payers. However, there are some concierge practices that do, bill some services to insurance companies (usually PPO plans).

Under Concierge/DPC, patients pay a monthly or annual membership fee to their pediatrician, who then provides them with a range of services such as preventative care, acute care, chronic disease management, behavioral health counseling, and more. This payment model allows for longer appointments and more personalized care, as the pediatrician is not constrained by the limitations of insurance billing codes and reimbursement rates.

• Services: Concierge/DPC focuses on primary care services

• Load: Both models have a lower patient-to-doctor ratio than traditional insurance-based practices and depending on the number of providers in the practice, which comes out to a maximum of 200-350 patients per provider. In comparison traditional insurance-based practices have 2,000-3,000 patients per provider.

Monthly subscription rates include all the following provided by Dr. Bost, an American Board of Pediatrics certified doctor:

• Home visits for newborns (living within 30 miles of the office) – yes, you do not need to bring your newborn into the office (I understand those challenges!)

• All well visits (check-ups). I actually like to see kids more frequently than the typical once a year well visit that is covered by insurance. Kids are constantly changing and growing.

• Unlimited sick visits (in-person or virtual)

• In-office testing for strep throat, flu, RSV, and COVID

• Provision of common medications - yes, no need to drag your sick child to the pharmacy for common medications (minimal additional charge may apply)

• All routine vaccinations provided through our partner Vaxcare (we administer the vaccines and Vaxcare bills your insurance)

• School/camp/sports physical forms

• Management of minor trauma, injuries, and lacerations (splinting, glue, wound management)

• Developmental and behavioral screenings

• Counseling and guidance (nutrition, development, sleep, toileting, behavior, parenting, and more)

• Management of chronic conditions such as eczema, asthma, ADHD, depression, anxiety, and more

• Care coordination for diagnostic testing, specialty care, emergency care and hospital care

Unfortunately, regular house calls went by the wayside in the 1960s. During this period, doctors started to focus on economic efficiency, inspiring a change to seeing patients in their offices. Additionally, in the 1960s, insurance plans became more commonplace, and the doctor-patient relationship moved from personal to more business-like.

During that transition in the 1960s it was thought house calls were "an inefficient use of doctors’ time", however, the almost complete elimination of house calls has not increased efficiency, it has only transferred the cost of travelling and waiting from doctors to patients.

We are your partner in all aspects of child health and development. I do not work for insurance companies as their regulations can limit the ability to advocate for your child. The Concierge/Direct Pediatric Care (DPC) model, by design, does not participate in medical insurance. This, in fact, is the secret sauce assuring the success of Concierge/DPC practices across the country. Removing insurance requirements allows us to provide a far higher level of care compared to other practices.

Your membership fee should not be considered insurance. It is recommended you still have health insurance. We may need to use your insurance information like for vaccine reimbursement. If that is not an option, there is a vaccine fee plus a vaccine administration fee. Some uninsured patients qualify for vaccines at no cost through the state funded Vaccines for Children Program (VFC). For diagnostic tests and x-rays, some insurances may cover. If covered, we will send your insurance information to the laboratory or radiology department to cover your child’s diagnostic testing, if needed.

And lastly, you will need health insurance in case your child needs to see a specialist, receive emergency care, or is hospitalized. In this model insurance is truly used as a safety net as are many other types of insurance you may carry.

YES. WE RECOMMEND YOU MAINTAIN HEALTH INSURANCE COVERAGE IN THE EVENT YOUR CHILD HAS A CATASTROPHIC EVENT THAT WILL NEED HOSPITAL OR EMERGENCY ROOM CARE. We suggest a PPO plan that allows us to coordinate your child's care best and will not need prior authorizations for referral to specialists. Typically, HMO plans may refuse to pay for any services or prescriptions not ordered by an in-network physician.

Anything not listed as included in the membership (see FAQ on included services) is not included.

Some Medications/Prescriptions not dispensed by Whole Pediatrics

Specialty Visits, Hospital Stays, ER Visits, Urgent Care Visits, Etc: Any Medical Services From Other Medical Providers Will Be Billed To Your Insurance By Those Providers.

Out-Of-Office Procedures such as Imaging, Or Labs.

In other words, if it is not something your doctor can physically do for you in the office, your standard insurance will apply.

The membership model is actually more affordable for many families! The savings becomes clear when you consider the lower cost of a high deductible health plan (HDHP), the avoided office visits for minor medical problems like some rashes and pink eye, the all-inclusive office testing for strep, flu, and COVID, and the likelihood that you will avoid several urgent care or ER visit every few years. In a traditional practice, all these visits would add up to several thousand dollars a year.

If you feel the Concierge model is right for you but that you cannot afford membership, speak with us. Since we do not take insurance, we do have limited reduced rate memberships available.