Understanding Your Primary Care Options

(So… are you just becoming a concierge doctor?)

I’ve gotten this question more than once since announcing Segno. The short answer is no, but it’s a very reasonable question.

Direct Primary Care (DPC) and concierge medicine can look similar from the outside. Both generally involve smaller patient panels, longer appointments, and easier access to your physician. But the way they are structured, how patients pay, and the role insurance plays are quite different.

And both are different from the traditional insurance-based primary care model most of us are used to.

Here’s how the three models compare

A more in-depth comparison:

1. Traditional Fee-for-Service Primary Care

Most primary care practices operate under a fee-for-service insurance model.

The physician or health system bills your insurance for each covered service or visit. You may then be responsible for a copay, deductible, coinsurance, or services your insurance does not cover.

Because practice revenue is largely tied to billable services and patient volume, traditional primary care physicians often care for large patient panels and see many patients each day,

2. Concierge Medicine

Concierge practices generally offer smaller patient panels, longer visits, and enhanced access to the physician in exchange for a membership or retainer fee.

Many concierge practices also bill insurance for covered medical services. That means patients may pay the concierge membership fee in addition to your insurance premiums, copays, deductibles, and other cost-sharing.

3. Direct Primary Care

Direct Primary Care changes the payment model itself.

Instead of billing insurance for primary care visits, a DPC practice charges patients a transparent membership fee that covers the primary care services included in the membership.

At Segno Primary Care, membership is $125 per month. There are no insurance claims for covered visits and no copays or deductibles for those visits.

Insurance is still important for care outside Segno, including specialist care, hospital care, labs, imaging, and medications.

Segno will also offer access to discounted cash pricing for certain labs, imaging, and medications, giving patients the option to compare those prices with the cost of using their insurance.

By removing fee-for-service insurance billing from primary care, much of the administrative work associated with coding, claims, and reimbursement is removed as well.

The goal is simple: more of your physician’s time can be spent taking care of you.

  
  Traditional Primary Care
  Concierge Medicine
  SEGNO PRIMARY CARE

  How you pay for visits

    Insurance billed; copays and deductibles may apply
  
    Insurance often billed in addition to membership fee
  
    Included in monthly membership; no insurance billing, no copays
  
  Membership fee

    None
  
    $200–$500/month

    (often billed annually)
  
    $125/month
  
  Visit length

    Often shorter, schedule-driven visits
  
    Generally longer visits
  
    Longer, unhurried visits
  
  Patient panel

    Generally larger
  
    Usually smaller
  
    Intentionally limited to 200–300 patients
  
  Access to your physician

    Usually through office staff or patient portal
  
    Enhanced access varies by practice
  
    Direct access to Dr. Lambeth
  
  Virtual visits

    Varies by practice
  
    Varies by practice
  
    Included when appropriate
  
  Care coordination

    Varies by practice
  
    Generally enhanced
  
    Included: records, results, specialists, and the whole picture
  
  Insurance still needed?

    Yes
  
    Yes
  
    Yes, for care outside Segno, such as labs/imaging, specialist care, and hospital care

	Traditional Primary Care	Concierge Medicine	SEGNO PRIMARY CARE
How you pay for visits	Insurance billed; copays and deductibles may apply	Insurance often billed in addition to membership fee	Included in monthly membership; no insurance billing, no copays
Membership fee	None	$200–$500/month (often billed annually)	$125/month
Visit length	Often shorter, schedule-driven visits	Generally longer visits	Longer, unhurried visits
Patient panel	Generally larger	Usually smaller	Intentionally limited to 200–300 patients
Access to your physician	Usually through office staff or patient portal	Enhanced access varies by practice	Direct access to Dr. Lambeth
Virtual visits	Varies by practice	Varies by practice	Included when appropriate
Care coordination	Varies by practice	Generally enhanced	Included: records, results, specialists, and the whole picture
Insurance still needed?	Yes	Yes	Yes, for care outside Segno, such as labs/imaging, specialist care, and hospital care

And, for the #1 most frequently asked question:

How Does Segno Work With My Insurance?

Real World Example #1: If You Have Medicare

Donna is 72 and has Medicare. She pays $125 per month for her Segno membership.

Donna develops fatigue and shortness of breath and sees Dr. Lambeth. After reviewing her history, examining her, and discussing her symptoms, Dr. Lambeth determines that she needs blood work, a chest X-ray, a cardiology evaluation, and a new medication.

Her visit with Dr. Lambeth is included in her Segno membership. Segno does not bill Medicare for Dr. Lambeth's care.

Dr. Lambeth sends Donna's lab and imaging orders to outside facilities that accept Medicare and sends the cardiology referral and prescription. Those providers bill Medicare normally for covered services, and Donna uses her Medicare coverage just as she otherwise would.

Segno can then review the results with Donna, help her understand the cardiologist's recommendations, and coordinate the different pieces of her care.

Segno membership → primary care with Dr. Lambeth
Medicare → covered care outside Segno, such as labs, imaging, specialist care, medications, and hospital care

  
          What Donna Needs
        
          What Segno Does
        
          How It Is Paid For
        
          Primary care visit
        
          Dr. Lambeth evaluates and treats Donna through her Segno membership.
        
          Included in her Segno membership. Medicare is not billed for care provided by Segno.
        
          Laboratory testing
        
          Dr. Lambeth sends the lab order to an outside laboratory.
        
          The outside laboratory can bill Medicare for covered testing, subject to Medicare's usual coverage rules.
        
          Imaging
        
          Dr. Lambeth sends the imaging order to an outside imaging facility.
        
          The imaging facility can bill Medicare for covered imaging, subject to Medicare's usual coverage rules.
        
          Specialist care
        
          Dr. Lambeth sends a referral when appropriate and coordinates with the specialist.
        
          The specialist bills Medicare normally for covered services.
        
          Prescription medication
        
          Dr. Lambeth sends the prescription to Donna's pharmacy.
        
          Donna can use her prescription drug coverage when applicable.

What Donna Needs	What Segno Does	How It Is Paid For
Primary care visit	Dr. Lambeth evaluates and treats Donna through her Segno membership.	Included in her Segno membership. Medicare is not billed for care provided by Segno.
Laboratory testing	Dr. Lambeth sends the lab order to an outside laboratory.	The outside laboratory can bill Medicare for covered testing, subject to Medicare's usual coverage rules.
Imaging	Dr. Lambeth sends the imaging order to an outside imaging facility.	The imaging facility can bill Medicare for covered imaging, subject to Medicare's usual coverage rules.
Specialist care	Dr. Lambeth sends a referral when appropriate and coordinates with the specialist.	The specialist bills Medicare normally for covered services.
Prescription medication	Dr. Lambeth sends the prescription to Donna's pharmacy.	Donna can use her prescription drug coverage when applicable.

  
          What David Needs
        
          What Segno Does
        
          How It Is Paid For
        
          Primary care visit
        
          Dr. Lambeth evaluates and treats David through his Segno membership.
        
          Included in his Segno membership. No insurance billing or copay.
        
          Laboratory testing
        
          Dr. Lambeth sends the order to an outside laboratory.
        
          David can use his insurance or, when available, choose discounted cash pricing offered through Segno.
        
          Imaging
        
          Dr. Lambeth sends the order to an outside imaging facility.
        
          David can use his insurance or, when available, choose discounted cash pricing offered through Segno.
        
          Specialist care
        
          Dr. Lambeth sends a referral when appropriate and coordinates with the specialist.
        
          The specialist bills David's insurance, subject to his plan's usual deductible, copays, coinsurance, and network rules.
        
          Prescription medication
        
          Dr. Lambeth sends the prescription to David's pharmacy.
        
          David can use his prescription coverage or compare available cash or discount prices.

What David Needs	What Segno Does	How It Is Paid For
Primary care visit	Dr. Lambeth evaluates and treats David through his Segno membership.	Included in his Segno membership. No insurance billing or copay.
Laboratory testing	Dr. Lambeth sends the order to an outside laboratory.	David can use his insurance or, when available, choose discounted cash pricing offered through Segno.
Imaging	Dr. Lambeth sends the order to an outside imaging facility.	David can use his insurance or, when available, choose discounted cash pricing offered through Segno.
Specialist care	Dr. Lambeth sends a referral when appropriate and coordinates with the specialist.	The specialist bills David's insurance, subject to his plan's usual deductible, copays, coinsurance, and network rules.
Prescription medication	Dr. Lambeth sends the prescription to David's pharmacy.	David can use his prescription coverage or compare available cash or discount prices.

Real World Example #2: If You Have a High-Deductible Health Plan

David is 48 and has a high-deductible health plan. He hasn't met his deductible yet, which means many of his healthcare expenses are currently coming out of his own pocket.

David also pays $125 per month for Segno.

He develops abdominal discomfort and sees Dr. Lambeth. His visit is included in his Segno membership, with no additional copay or visit charge.

After evaluating him, Dr. Lambeth determines that he needs blood tests and an abdominal ultrasound.

This is where having insurance and Direct Primary Care can give David more choices.

David can use his insurance for the testing. Segno sends the orders, the lab and imaging center perform the tests, and those providers bill his insurance. Because David hasn't met his deductible, he may be responsible for much or all of his plan's negotiated price.

But insurance isn't necessarily the least expensive way to purchase every healthcare service. When discounted cash pricing is available through Segno, David can compare the two options and choose the one that makes the most sense for him.

Where David May Save Money

Suppose David's blood work would cost him $150 through his insurance because he hasn't met his deductible. If the same testing is available for a $45 discounted cash price, he can choose the $45 option.

Blood work: $150 → $45
Potential savings: $105

The same may be true for imaging:

Ultrasound: $300 → $150
Potential savings: $150

Prescription medications can work similarly. Sometimes insurance is the least expensive option; other times a cash or discount price may be lower. Segno can help patients compare the available options.

In this hypothetical example, David saves $255 on just two services.

That's one of the advantages of separating primary care from insurance: insurance remains available for the things it does well, while patients have the option to use lower-cost alternatives when those make more sense.

Actual prices and savings vary by test, facility, medication, and insurance plan. Cash payments generally do not count toward an insurance deductible or out-of-pocket maximum.