How Segno Works
(Primary care, with enough time to actually do primary care)
Segno Primary Care is a direct primary care (DPC) practice in Winston-Salem, North Carolina, offering personalized adult primary care and internal medicine (acute and complex) through a simple monthly membership. Founded by Dr. Sally Lambeth, Segno is designed around longer appointments, direct physician access, and lasting doctor-patient relationships.
In other words, the way medicine was always meant to be.
UNDERSTANDING SEGNO
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Yes! Segno Primary Care is currently welcoming founding patient commitments ahead of our January 1, 2027 opening.
To preserve the time, attention, and personal relationships that define Segno, I will be intentionally keeping my patient panel small (around 200, as opposed to the 2000-3000 patients often seen in traditional primary care practices).
Committing now simply reserves your space. There is no payment required at this time, and membership billing will not begin until January 1, 2027.
As a thank-you to my earliest supporters, the $150 enrollment fee will also be waived for the first 50 patients who commit.
Not quite ready to commit? I’d love to meet you! Schedule a complimentary video or phone Meet & Greet to ask questions and see whether Segno might be the right fit for you.
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Segno will be a Direct Primary Care practice, usually shortened to DPC.
Instead of billing insurance every time I see you, members will pay a monthly fee directly to the practice. In return, I can keep my patient panel much smaller than it would be in a traditional insurance-based practice.
That smaller practice is really the point.
It means longer, less rushed appointments. Better access to me when something comes up. Time for me to review your records comprehensively before I walk into the room, so that you are not in a position to have to quickly summarize 40+ years of your medical history. And time afterward to follow up on what we discussed.
It also means that if you have seen several specialists and now have four sets of recommendations, somebody can sit down and help you figure out how they all fit together.
That somebody would be me.
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Segno is for adults who want a closer, more personal relationship with their primary care physician and more time to address their health concerns.
Some patients may be generally healthy and looking for thoughtful preventive care and a physician who knows them well. Others may be managing multiple chronic conditions, seeing several specialists, or trying to make sense of a complicated medical history and recommendations that don’t always seem to fit together.
Segno may be especially helpful for patients who value having one physician who knows their history, keeps track of the bigger picture, and has the time to help them understand their options and make informed decisions about their care.
You don’t need to have complex medical problems to benefit from Segno. The common thread is simply wanting more time, continuity, access, and coordination than is often possible in traditional primary care.
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Segno is being designed to provide comprehensive adult primary care, including:
Visits with Dr. Lambeth as often as medically needed, without a per-visit charge.
Routine and preventive care
Longer appointments (30-60 min) with time to address more than one concern
Sick visits and evaluation of new medical problems
Same- or next-day appointments when available and medically appropriate
Management of chronic medical conditions
Comprehensive medication management
Review and explanation of lab and imaging results, available specialist notes and recommendations
Coordination of care among specialists, including communication WITH specialists when appropriate
Women's health, including concerns related to midlife and menopause
Virtual visits when desired and medically appropriate
Easier access and communication when questions or problems arise
Procedures included in membership fee:
EKG
Urinalysis
Rapid flu testing
Rapid COVID testing
Rapid strep testing
Blood glucose testing
Additional diagnostic services: stay tuned
And, importantly, you won't need to save up six unrelated problems for your annual physical and then try to mention all of them while your doctor is backing slowly toward the door. That's not how I want primary care to work.
A Segno Membership is not health insurance and does not replace health insurance. Membership covers the primary care services described in the membership agreement. Patients should maintain appropriate insurance coverage for services outside Segno, including specialist care, hospitalization, emergency care, imaging, medications, and other services not included in the membership.
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Individual adult
$125/month
Two adults in the same household
$225/month
Each additional adult child in the household
+$100/month
Membership covers primary care visits with Segno with no copays or per-visit charges for included care. There is no set number of visits per year; some patients may need only a few visits, while others may need more frequent care.
A one-time enrollment fee of $150 per household applies to new memberships. The enrollment fee is waived for the first 50 patients who commit to joining Segno as founding patients.
Founding patient commitments are now being accepted. There is no payment required to commit, and membership billing will not begin before January 1, 2027.
Ready to join? Click here.
*Additional costs may apply for services not included in membership, such as certain laboratory testing, imaging, medications, and supplies. These are explained in the sections below.
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Yes. There is no set number of visits included in your membership. Some patients may need to see me only a few times a year, while others may need more frequent care. There are no copays or per-visit charges for care included in your membership.
Not every concern requires an office visit. When appropriate, we may be able to address questions or follow up on an issue by secure messaging, phone, or video visit. When an in-person evaluation is needed, we’ll schedule one.
This flexibility can be especially helpful for people with busy schedules, difficulty getting away from work or family responsibilities, or transportation challenges. Sometimes a quick phone call, message, or video visit may be all that’s needed.
The goal is to use the type of visit or communication that makes the most sense for the situation, rather than requiring an office appointment simply because that’s the only way to reach your physician.
SEGNO + YOUR INSURANCE
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Yes.
This is important. A Segno membership does not mean you get to throw your insurance card away.
You will still need health insurance or Medicare.
Your insurance remains important for things outside Segno, including hospital care, specialists, imaging, procedures, medications and other services that aren't provided through the practice.
The difference is that Segno will not bill your insurance for the primary care services I provide, which are included in your membership. Those services will be provided directly through the practice as part of your monthly fee.
Think of insurance as protection against the expensive things that can happen in medicine. Your Segno membership is what gives us the time and access to take care of the everyday things, the complicated things, and hopefully quite a few things before they become expensive things.
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You keep your health insurance or Medicare and continue to use it for care outside of Segno.
For example, if I determine that you need an MRI, a consultation with a specialist, a colonoscopy, physical therapy, hospital care, or another service outside the practice, you can use your insurance for those services just as you normally would.
And my role doesn’t end when I send you somewhere else. I will help coordinate your care, review specialist recommendations and test results, explain what they mean, and help you decide what comes next.
And when there is an alternative to using insurance, such as a transparent cash price for a lab, imaging study, or medication, I'll help you understand those options too.
Your insurance continues to cover eligible healthcare outside Segno. Segno gives you a primary care physician with the time to help you navigate it.
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The answer may surprise you: sometimes, yes.
Price transparency is one of the advantages I hope to bring to Segno.
Keeping insurance doesn’t mean we have to use it for everything.
For some labs, imaging, and medications, paying a negotiated cash price can actually cost LESS than going through insurance, particularly if you have a deductible to meet. Part of my job will be helping you figure out when that’s the case.
One of the frustrating things about healthcare is how difficult it can be to know what something will cost before you receive it. Even physicians often don’t know what a patient will ultimately be charged for a test, medication, or procedure.
If I order blood work, or an MRI, for example, I don’t want the conversation to end with “Here’s the order. Good luck out there.” When possible, I’ll help you understand your options and what they are likely to cost.
Sometimes using your insurance will be the least expensive choice. In other cases, a direct cash price may be surprisingly lower. When there is a choice, I’ll help you compare the costs and decide which option makes the most financial sense.
I plan to partner with local laboratories and imaging providers that offer transparent cash pricing, giving Segno patients another option to compare with the cost of using their insurance. Any discounted pricing available through these arrangements will be passed directly onto patients, without markup.
Prescription medications can work the same way. For some medications, discount programs such as GoodRx or pharmacies such as Mark Cuban Cost Plus Drug Company may offer a lower price than an insurance copay. I’ll help patients consider these options when appropriate.
Eventually, I also hope to dispense a limited selection of commonly used generic medications, directly through Segno at or near cost. I won’t be doing this when the practice first opens, but it’s something I’m seriously considering exploring for the future.
The goal isn’t to convince you never to use your insurance. It’s to bring more transparency to healthcare costs and make sure you know when a less expensive option may be available.
Here’s a particularly eye-opening article I read recently that illustrates just how different the price of the same healthcare service can be, depending on how you pay.
Stay tuned for real-world examples of what commonly ordered lab tests, imaging studies, and medications can cost when transparent cash pricing is available.
Click here for more detail about Medicare and Medicare Advantage plans
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Segno welcomes Medicare beneficiaries. Because I have opted out of Medicare effective Jan 1, 2027, special rules apply to how we establish our physician-patient relationship and bill for care.
Segno’s membership fee is not insurance and is not paid or reimbursed by Medicare. Medicare beneficiaries who receive care from me will be required to enter into a separate Medicare private contract, and neither Segno nor the patient will submit my services to Medicare for reimbursement.
This does not mean giving up Medicare. Medicare may continue to cover eligible services you receive elsewhere, such as specialist care, hospital care, laboratory testing, imaging, and medications, subject to the usual Medicare rules and coverage requirements.
I will provide additional information specifically for Medicare beneficiaries before enrollment.
OTHER DETAILS
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The primary care services I provide are included in your monthly membership, with no copays or per-visit fees.
Services provided outside of Segno - such as medications, laboratory testing, imaging, care from specialists, hospital care, and emergency care - are not included in your membership. You may use your health insurance for these services when appropriate.
Your Segno membership does include my time to order tests and referrals, review and interpret results, coordinate with specialists, and help you understand what comes next.
When lower-cost cash options are available for labs, imaging, or medications, I can help you explore those as well.
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Some basic in-office testing will be included in membership. Other laboratory testing, imaging, and other services are not included, and you can use your health insurance for these services as you normally would.
For blood work, I plan to make the process as convenient as possible. Some blood draws may be available through Segno, although Labcorp or Quest may charge a small collection or processing fee. If so, that cost will be passed along to the patient without markup.
As the practice grows, I plan to add a medical assistant who can provide phlebotomy and other in-office services, allowing more routine blood work to be collected directly through Segno.
When testing isn’t included in membership, there may also be an option to pay a transparent cash price rather than use insurance. See “Could paying cash cost less than using my insurance?”
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Home visits may be available in certain circumstances. These visits are arranged individually at Dr. Lambeth’s discretion and are not a substitute for emergency care.
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Pain is a common part of primary care, and I will absolutely evaluate and treat painful conditions. My approach may include non-opioid medications, evaluation for underlying causes, imaging or other testing when appropriate, physical therapy, injections when within the scope of the practice, and coordination with specialists.
Segno will not provide chronic opioid therapy or ongoing controlled-medication management for chronic pain. Patients who require those treatments will need to receive them through an appropriate pain-management specialist. That does not mean I stop helping with your pain. I will continue to work with you on other treatment options and help coordinate your overall care alongside your pain specialist.
Here is the basic idea behind Segno: A model that allows me the time to take really good care of each of my patients.
That sounds remarkably simple. In modern medicine, it is not.
Primary care has gradually become a system in which physicians are expected to see more patients, in less time, while also keeping up with test results, refill requests, messages, forms, quality measures, prior authorizations, and an electronic medical record.
Much of that work matters, Some of it does not. But all of it takes time, and too often that time comes at the expense of the patient sitting in front of us.
What is the biggest thing we have lost in this “new era” of healthcare? Time. The next biggest (and related to the first): loss of autonomy. Too often, physicians find themselves answering to the priorities of health systems, insurers, and administrative requirements, when what they really want is more time to take care of patients.
I want time to listen to the whole story. Time to address more than the single problem that technically fits into today's appointment. Time to look back through old records and notice a pattern. Time to explain what your most recent lab work actually MEANS. Time to explain those X-ray or CT scan results (and even SHOW you the pictures - it’s YOUR body, after all!). Time to figure out why three specialists have given you three slightly different answers, and time to help you make sense of their recommendations and how they all fit together. Time for me to actually communicate with those specialists when needed. I want the freedom to make decisions based on what benefits the individual patient in front of me, rather than what best serves an administrative metric or business model.
Segno was created around that idea.
Ready to become part of Segno?
Reserve your place as a founding patient today—no payment required. Membership begins January 1, 2027, and the $150 enrollment fee is waived for the first 50 patients who commit.
My patient panel will be intentionally limited to approximately 200 patients to preserve the personal, relationship-centered care that defines Segno.
It’s free! I’d love to meet you!
Yes, I care what you think, and what you are looking for!
As Segno prepares to open, I’d love to hear what matters most to you in a primary care relationship. This short survey will help me make thoughtful decisions as we approach Jan 1.
You’ll receive occasional emails with important Segno updates, including opening dates, enrollment information, and other practice news.
I love talking medicine, but for your privacy, please do not include personal medical information in your email.
Note: If you have in-depth questions (or just want to meet the person who may become your doctor!) please take advantage of a complimentary meet and greet by clicking here.