One of the most common questions I hear from prospective patients is: “Do you work with insurance?” This makes sense, navigating healthcare can be confusing, and you want to know how a direct primary care clinic like Sana Sana fits with your insurance plan. The short answer is yes, I can work with any insurance. However, I do things a bit differently here than a traditional insurance-based office, so let me explain how it works (and why many of my patients, both insured and uninsured, love this model).
How Sana Sana Clinic Works With Your Insurance
At Sana Sana Clinic, I don’t bill your insurance for primary care services, which includes all the care provided directly by me and my clinic. Instead, I operate on a simple membership model with transparent flat fees, meaning no co-pays, no deductibles, and no surprise bills for your regular visits. You still use your insurance for everything else, and that part is key. If you need blood tests, X-rays, MRIs, specialist visits, surgery, or a hospital stay, your insurance can be used just as it normally would. In other words, joining a direct primary care (DPC) practice doesn’t mean giving up your insurance; it means you have personalized primary care outside the insurance bureaucracy, while keeping your insurance for the big stuff (like specialists or emergencies).
Here are some examples of how my patients use their insurance alongside DPC:
- Medications: You’re free to use your insurance at the pharmacy, but many of my patients are pleasantly surprised that my in-house medication prices can match or beat their usual co-pays while saving them a trip to the pharmacy. (More on that below!)
- Lab tests: If I order lab work, you can choose to have it done at any covered lab through your insurance, or take advantage of my negotiated low cost cash prices available to all my patients. Either way, you get the results you need.
- Imaging: If you need imaging services, I can send the order to a local imaging center that takes your insurance, or guide you to a center with my negotiated cash price. Insured patients can absolutely apply their coverage for diagnostics if that’s best for them.
- Specialist visits: If you need to see a specialist, I’ll help coordinate that referral. With the majority of insurances, you can go directly to in-network specialists with my referral.
- There is one type of insurance coverage, the HMO plan, which typically requires you to use your insurance’s primary care provider for specialist referrals. I’ll work with you on the best approach, which usually entails collaborating with the HMO assigned primary care provider. Rest assured, we make sure you get to the right specialist and that your insurance can be used for those visits.
No Insurance? No Problem
If you don’t have health insurance, you can still join Sana Sana Clinic and get excellent care. In fact, one of the beauties of the DPC model is that it removes the insurance middleman for primary care. Your membership covers unlimited primary care visits, longer appointment times, and direct access to me when you need it. I’ve also worked hard to make common labs and medications affordable at cash prices for my patients. For example, routine blood tests can be done at special member rates drawn at a major lab under my clinic’s discounted cost. At this time, I am able to offer the typical labs for a yearly annual for between $35-$70. I pass along the cost for these labs in your next monthly invoice without markup. I also keep a stock of generic medications in the office so that you won’t pay retail prices. Most basic prescriptions cost only a few dollars at Sana Sana Clinic, often far less than the typical pharmacy price, and I am able to prepare and dispense the medications at the time of your visit so that you leave with medications in hand.
While I am happy to accept patients who do not have insurance, I still recommend having some form of coverage for major unexpected events (like hospitalizations or surgeries), because DPC isn’t a substitute for catastrophic insurance. But for your day-to-day healthcare needs, I’ve got you covered regardless of coverage status.
How Insured Patients Benefit from DPC
If you do have insurance, you will have the advantages of insurance with me in your corner. Many insured patients can save money and definitely save time and hassle with the DPC model. I wanted to provide an example below on how that might work with medications, and why even some insured patients opt to take advantage of my discounted medications.
My in-house dispensary stocks generic medications at wholesale prices. Many common prescriptions are available to members for just a few dollars, often beating typical insurance co-pays. For example, I offer a 90-day supply of lisinopril (a common blood pressure medication) for around $3, far cheaper than the typical $5-$15 co-pays many patients would usually pay at the pharmacy for three months of that same drug. Unlike a traditional pharmacy, you pick up your meds directly during your visit. No extra trips, or pharmacy lines to wait in, which can be especially useful when you’re feeling sick and eager to get home and rest.
Beyond the discounted prices, the greatest benefit remains the time and personal attention, which can help you get the most out of your insurance coverage. In a typical insurance-based practice, doctors are swamped with large patient panels and piles of paperwork, which means less face-to-face time for you and very little time to deal with insurance hassles. In contrast, I deliberately keep my practice small, which allows me to spend 30-90 minutes with patients per visit instead of 10 hurried minutes. It also means I can go the extra mile when something does involve your insurance. For instance, if your insurance requires a prior authorization for a medication or test, I have the time to handle that paperwork and phone call on your behalf – so you’re not left navigating that frustrating maze alone. Not-Fun fact: traditional practices average nearly 40 prior authorizations per physician per week, taking up about 13 hours of staff time. Nobody enjoys spending a long time talking to insurers, but In my DPC setting, I can dedicate the needed time to advocate for you personally, and get these approvals done, whereas overburdened offices often struggle to keep up.
Finally, remember that insurance is best used as a safety net, for those high-cost events you can’t predict. It’s not really designed for affordable, ongoing primary care. As I often remind patients, health insurance is not the same as healthcare. You can read more about that in my previous post on just that topic here: Health Insurance is not Healthcare.
By pairing a DPC membership with your insurance, you get the best of both worlds: high-quality, personalized primary care with no barriers, and your insurance still in place to back you up for specialists and emergencies.
The Bottom Line: Sana Sana Has You Covered
Whether you have great insurance, a bare-bones plan, or no insurance at all, Sana Sana Clinic is set up to take care of you. If you’re insured, rest assured you can continue using your insurance as normal for any services I order outside the clinic, I’ll be with you at every step to help coordinate and navigate the complicated insurance system. If you’re uninsured or prefer to pay directly, you’ll find my pricing often beats insurance rates for routine meds and labs. In all cases, you’ll get unhurried, attentive care in a friendly, membership-based model that puts you first.
Still have questions about how this works? Feel free to reach out or schedule a free meet-and-greet to talk it over. It’s my goal to make healthcare easier and more accessible, and that includes helping you make the best use of your insurance (or finding alternatives if you don’t have it). At the end of the day, the question “Do you work with insurance?” can be answered with a resounding “Yes!” and I make sure that whether you’re insured or not, you’re in good hands here.
