Frequently Asked Questions

Frequently Asked Questions


What is a direct primary care?

Direct relationship between patient and physician without any third-party involvement for primary care service that is very personal, simple, convenient, comprehensive and affordable. It is a membership model of care. For a very affordable monthly fee, without any hassles or hidden charges. You receive:

  • Comprehensive, Personalized,convenient care.

  • One annual comprehensive physical.

  • Relaxed, Unhurried, Office Visits with minimal to no wait time.

  • More time with your physician.

  • Unlimited email/phone/ video communications with your provider

  • Expanded communication through email, video and phone

  • Discounted fees for exams, labs and other health care services

  • Members get certain routine laboratory tests included once per year

  • Some basic procedures included (medication and supplies fee extra)

  • Discount on labs, medications and radiology

  • Reduced Urgent Care or ER visits because 24/7 direct contact with your doctor for advice which can often prevent a trip

  • Free samples and other promotional deals if and when available at discounted membership prices. Many more (see benefits of membership).

What is the difference between direct primary care and concierge medicine?

These terms are often used interchangeably, but direct primary care usually refers to a membership based practice with a very affordable monthly membership fee while concierge medicine often refers to a high annual monthly retainer fee that is often several thousands of dollars and your insurance is typically billed as well by the practice in addition to the yearly fee.

Direct primary care is focused on direct access to your doctor. The term direct implies that the middleman or “insurance” has been removed and the relationship has return to its roots – a direct relationship between patient and physician. It is about putting the patient first and giving the patient direct access to the doctor. It is about getting a phone call from your doctor about your results and having access to your doctor by email to just ask a question you may have via phone. With insurance eliminated, discounts in pricing and overhead costs can be passed directly on to you.

What sets Nirog Health Center apart from other practices?

Our model is designed to be very affordable, convenient, personal and comprehensive. We not only have the ability to provide you with all of the basic primary care services you would see at a traditional Primary care/internal medicine practice, but we also provide you with expertise in infectious diseases, integrative medicine and much more. We keep our services prices down and pass the savings to our patients by keeping overheads low. We do not bill any insurance companies, so we don’t have to deal with coding, billing and lots of paperwork in order to get paid by insurance companies. Since you are paying direct to doctor, your doctor is working for you and is on your side rather than worrying about “getting paid by “middleman”- insurance companies”.

Does Nirog Health Center take insurance?

We Do not bill or receive any payments form any insurance company. We do not take any insurance, but do not let that scare you. Often our patients end up saving money. We have chosen to forego insurance payments in order to save our patients from the arbitrary decisions insurance companies make that often hinder their care. By not taking insurance, we also can save our patients from the expensive overhead keeping us from passing on wholesale pricing on to you.

Why don’t you take insurance anymore?

We are in the medical field to take care of people. Insurance regulations and Medicare laws were interfering with our ability to do this. Filling out paperwork and trying to keep up with all the bureaucratic rules were taking too much time from our time with our patients. We would rather work directly for our patients than any insurance company or bureaucrat.

If I have insurance, why would I need direct primary care?

For these reasons: convenience, reduced hassle, more personalized care and attention, personalized help navigating the health care system, the comfort of knowing you have a health care advocate on your behalf, and reduced cost for out of pocket expenses. Since you are paying the Doctor directly, your Doctor is working for you and not for any third party. It’s like having a family Doctor in your family who is accessible when you need help getting your health questions answered. Whether you have insurance through your employer, individually, or through the Obamacare exchange, membership in a DPC practice probably still makes good sense. Even when most people had insurance deductibles of $2000 or less per year, over 90% of patients never reached those deductibles, so they ended up paying almost all of their health care costs out of their own pocket. Now that deductibles are going up, often as high as $6000 per year for an individual, almost no one will reach their deductible, unless they have a major illness or accident. A family physician can take care of approximately 80-90% of most people’s medical problems. For an annual cost of <$600/year, which may be only 10% of your deductible, we can handle up to 90% of your medical care. For every emergency room visit we prevent, we save our patients the equivalent of 2-5 years of subscription payments.

I have very minimal health insurance or a high-deductible plan, is this right for me?

This membership is perfect for you. Let your high-deductible plan do what it does best, take care of catastrophes. If you have a high-deductible plan, you may be paying out of pocket for your yearly basic primary care needs anyway. Rather than avoid the doctor’s office and go to urgent care only when you are in dire need, create a relationship with a primary care doctor and avoid time consuming office visits. Join our membership practice at Nirog Health Center.

What are the monthly membership rates?

Age years Price
Adults 18-50 $50
Adults 50+ $80

Are there family specials?

Yes! We love our families and recognize they come in all ages, sizes, and backgrounds. We offer the following monthly plans:

Yes! We love our families and recognize they come in all ages, sizes, and backgrounds. We offer the following monthly plans:

  • Couples plan (2 adults age 18 to 50 years, no children) – $80/month
  • Couples plan (2 adults age 50 +, no children) – $120

* Additional family member (age 18 +living in same household) may be added to Family plans for $ 40 per person.

What about laboratory tests?

For applicable patients, Basic labs such as CBC, CMP, thyroid studies, c reactive protein, prostate specific antigen, hemoglobin A1c, strep testing, urinalysis, pregnancy testing, and HIV are included in the membership. EKG and spirometry testing (for lung function) are also included. We have negotiated special rates for more advanced laboratory tests as well. You may also still use your traditional insurance.

Do I have to pay monthly?

You may choose to pay your complete one-year membership up front at a 10% savings or we can set up monthly re-occurring payments. All programs have a 6-month commitment. Our six-month program is perfect for Snowbirds! Continue your membership and you can take advantage of our telemedicine services from miles away!

What if I need to see a specialist?

We are negotiating special rates with some of the area’s best cardiologists, neurologists, pulmonologists, hematologists, ENT, Dentist and orthopedic physicians, which we will pass on to our patients. You can always see the specialist physician of your choice and use Medicare or your traditional insurance. At Nirog Health Center, we strive to provide the greatest breadth of services that we can, so that the need to see a specialist is limited. However, when a patient’s case is complex or if you feel you just want to seek a specialist’s advice, we can coordinate your care with the specialists. If you decide to see a specialist of your choice tehn please let the specialist know that Nirog Health Center is the home of your primary care physician, so that we can be sure to receive the appropriate consultation information and keep accurate information on any changes in your care that may occur after your visit.

What if I need an imaging study?

We are negotiating special, members only rates for x-rays, ultrasounds, bone density, mammograms, and CT scans with the areas most respected Radiology group. You may also choose to use Medicare or your traditional insurance.

Do you manage chronic pain?

Chronic pain is a very common and understandably frustrating medical problem. It is best treated by specialists who are trained specifically in this area of medicine. We do not treat chronic pain at Nirog Health Center but are happy to help arrange a referral for you to a pain management specialist. Please do not expect to receive any prescriptions for pain medications at your first visit as we do a thorough recordreview prior to making a determination.

Wedo manage minor acute injuries, aches and pains.

We do not store or dispense any controlled pain medicine in the clinic and prescribe all medications electronically.

What about pap smears?

For applicable patients’ Pelvic exams are included with a $32 or $82 additional pathology fee (depending on the type of testing done) payable at time of service.

Will my health information be shared with insurances if I invest in a membership?

Under applicable HIPAA rules, patients have the right to restrict any Personal Health Information shared with third-party insurers and health plans, IF they pay for the services themselves. If you value your privacy and don’t want your health information shared with third parties, Nirog Health Center membership is a great option for you!

Can I get membership through my employer?

Yes! Knowing what employee health expenditures will be of key importance to a business’ bottom line. Nirog Health Center employee memberships allow companies to better forecast their health care expenditures and provide valuable benefits to retain talented employees. We are glad to speak with your employerto explore this option.Medical services enrollment for employees is a great option for small business owners and self-funded companies who are looking to provide great benefits for themselves and retain great employees and save time. Even if your employer doesn’t cover the membership, it is still a valuable investment in your health. Employer-based health insurance is a great option for people guaranteed to have their job benefits for life, but in today’s environment that is rarely a guarantee. Your Nirog Health Center membership allows you to take control of your health care!Here at Nirog Health Center, we believe in the saying “an ounce of prevention is better than a pound of cure”. Current health care plans available to small businesses in the current marketplace, just are not able to offer such comprehensive primary care services.

Can you recommend a health insurance to go with the plan?

Choosing a health insurance plan is highly individualized. A high deductible plan may make sense for a relatively healthy person with few medical issues, while a more traditional plan may be appropriate for someone with more complex medical issues. We are happy to share the contact information of helpful health insurance agents. If you plan on purchasing your insurance on the exchange you could consider a high deductible plan for your needs. There are also several private plans available to cover unexpected emergencies.

In addition to traditional insurance, there are faith based and non-faith based, voluntary, healthcare cost-sharing ministries that are acceptable options to meet the individual mandate for health cost coverage in the Affordable Care Act. They include

It is very important to carry some type of insurance for life’s unforeseen medical emergencies. High Deductible plans (also known as catastrophic coverage) make an excellent accompaniment to the Family First Access Wellness Program as do cost sharing ministries.

You’ll use your insurance or cost sharing ministry for the big stuff, and for everything else, there’s Family First Access Wellness!

Is this tax deductible?

Many Health expenses do qualify in part but please speak to your CPA or financial advisor for specific answers on what would be best for you.

As a patient of Nirog Health Center, do I still need insurance?

Yes. Insurance works best for covering catastrophes and big-ticket medical expenses. You want insurance to cover major medical issues in case you are hospitalized, in an accident or if you develop a major medical illness that requires a lot of advanced testing or specialist care. For these reasons, we recommend you still have some basic insurance coverage. We are happy to refer you to insurance representatives to help you find a plan that fits your needs and your membership.

Does Nirog Health Center Accept Medicare?

No. When Medicare is your primary insurance you may become a member of our practice and pay a monthly membership fee for non-covered Medicare Services outlined in the membership agreement. We do not bill or receive any payments from Medicare as we have opted out of Medicare. Also,we do not accept Medicare with secondary coverage, or any Medicare Advantage plans at this time. You can still use your Medicare for other services (Labs, medications, referrals, procedures and other tests etc.).

What happens if I need to go to the hospital?

Our goal at Nirog Health Center is to keep you out of the hospital as much as possible. Hospital care has become so complex nowadays that there are physicians who work solely in the hospital to take care of you while you are there. We do not go to provide any hospital coverage at this time. If you go to hospital, then please notify them that you are a member of our practice and we will work with them to ensure that they have the most updated information on your health while you are there.

Can children and infants become members of Nirog Health Center?

Currently we are only accepting patients age 18 +. We do offer Family Plans with children > age 18 and other family members >age18 living in same household.

Can I contact my physician after hours?

Yes, that is a benefit of the membership.

What if I need medical care away from home?

As long as you are within the United States, we are happy to provide care for you over phone, email or text. We also provide E visits. Just contact us as you would normally do, and we will see what we can do to help you while you are away.

What if I want to cancel my membership?

You may cancel at any time with 90-daynotice.

Do you have a refund policy?

If your membership is terminated and you have paid annually, we will retain the monthly payment at our non-discounted fee for the months of participation and refund the remainder for you.

How do I know if Nirog Health center is right for me?

Please stop by and meet us in person. To schedule a no obligation, 10-15-minute Meet and Greet visit to learn more about our membership, just call our office email us or send a message from our web page, www.niroghealthcenter.com

Is DPC qualify as insurance under the “Affordable Care Act” (aka Obamacare)?

A DPC membership is not insurance. It should be considered more like a personal service contract with your doctor. We strongly recommend that our patients partner their DPC membership with a high deductible health insurance policy or a faith-based health ministry sharing membership. (We can provide you with more information on this option.). The combination one of these arrangements and DPC membership should shield you from penalties. We also recommend the use of health saving accounts (HSAs) to bridge the gap to pay for services we cannot provide in our office, up to the point the high deductible is reached.

Can I pay for DPC membership with my health savings account?

That is a good question. While it makes perfect sense that HSA funds should be able to be used to pay your DPC doctor, there is nothing we can point to in the tax code saying that it is permissible. There are bills in front of the U.S. Congress to fix this oversight. Until they are passed, we recommend consulting your accountant or tax preparer.

How is this good for patients?

By taking the insurance companies and the government out of the doctor/patient relationship, the doctor works for you. You can rest assured that the choices we make for you about your care are not influenced by your insurance company or any other organization that could gain from you not getting what you need. We will be able to respond to your needs, not the demands of the insurance companies. We work for the benefit of the patient, not the stockholders of an insurance conglomerate. Your care can never be rationed if you are paying for it yourself. You are paying direct to your doctor so you are in control and your doctor is working for you and is on your side.

For which patients will this work best?

This type of medical practice will benefit many different types of patients. Patients who have no insurance or patients who have high deductibles will probably spend much less money for medical care in this office. Patients who have PPOs (Preferred Provider Organization) who do not need referrals for care may or may not spend slightly more for care with us, we are confident that the level of service will more than make up for the financial cost. Patients with government insurance (Medicare/Tricare) will pay more. Again, we are sure that the service we offer will be worth it for most people. For patients who have HMOs with strict network restrictions, this may be a more difficult proposition if they require you to be seen by a doctor in the insurance company’s network to get referrals.

Can I get reimbursed by the insurance company?

NO, it is unlikely that any insurance company would reimburse you for our subscription fees.

Can I get reimbursed from Medicare?

NO. The government has very strict rules about this. If a doctor has “opted out” of Medicare, he/she cannot submit bills to them for at least 2 years. Medicare patients must sign an acknowledgement of this, with the understanding that they are forbidden from asking for reimbursement for our office visits. These rules apply only to services performed in our office. For any other services outside of our office services you can still use your Medicare insurance as applicable.

I have Medicare; can you refer me to specialists? What about labs, X-rays, medicines and other supplies?

We can still refer you to specialists who take Medicare. We can also order medical services and supplies from vendors who accept Medicare (for oxygen, visiting nurses, physical therapy, medical equipment, etc.) We can order X-Rays, CT scans, MRIs, and other procedures, which are done outside our office. These should be covered under your insurance just like it always had been. The facility doing the test will bill your insurance company. Labs that we draw in our office that we send to an outside lab (cholesterol panels, liver and kidney functions, thyroid tests, blood counts, etc.) will also be covered by your insurance as before. Services that we provide in the office, such as EKGs, breathing tests, urine tests and finger prick blood tests will not be billed to your insurance and will be part of our bill to you. Prescriptions will be covered under your current insurance as before.

I have commercial insurance; can you refer me to specialists?

For patients who have PPO insurance, there is not usually a referral required. For people who have HMOs with very strict network requirements, we should be able to make referrals as well but may be limited to send you to “in network “specialistsonly otherwise you may have to pay “out of network fee to see a specialist. We strongly recommend that you check with your insurance company to find out if this will present a problem or not.

Why don’t more doctors practice this way?

ALL of the doctors with whom we have talked before making our decision to change our practice are concerned about the future of medicine. Most are afraid of trying something new. The direct pay model has been working well in other parts of the country. We are proud to be the first practice in Jacksonville, FL to provide this service.

What makes DPC preferable to urgent care/minute clinics/convenience clinics as well as to telemedicine?

DPC docs offer the same services but w/ relationship & continuity, which are critical for the best health outcomes. 24/7 access to YOUR physician. Not whoever is “on” at the Urgent Care or retail clinic or flavor of the month telemedicine platform. YOUR doctor knows you and your family. Your DPC doctor KNOWS you, your history and has an ongoing clinical knowledge of your health keeping your medical record all in one place. Continuity. It also includes telemedicine providing the support, advice or treatment from home, work or on vacation when possible.

What makes DPC an ideal option to help address physician burnout in traditional primary care?

Getting off the hamster wheel. Taking way better care of patients. Practicing medicine, the way you were trained not the way the “suits” tell you to.

Ready to enroll ?

There is no reason to wait until you’re sick. In fact, we would rather start by seeing you at your best. It will help us keep you that way! Send us an email or call with any questions. If you’re ready to make the best investment in your and your loved one’s health.

When can I join the practice?

Now. Just follow the link below, call us, send message or stop by the office.