Frequently Asked Questions
What is Direct Primary Care?
Under the Direct Primary Care (DPC) model, the patient (you) receives comprehensive primary health care directly from your DPC provider. The patient pays for this care through a monthly fee, paid directly to Acadia Integrative Medicine.
Because DPC practices do not participate in any insurance plans, providers are able to avoid the ever-increasing and costly documentation demands and administrative intrusions that come with accepting insurance. DPC practices also avoid the burdensome patient data collection responsibilities that many plans impose—requirements that demand staff, time, and money, often resulting in significant intrusions on patient privacy.
By avoiding these insurance-related obligations, DPC physicians can devote more time to listening to and treating patients. And by eliminating the substantial overhead costs of participating in insurance, DPC physicians can pass the savings on to you, the patient—while providing compassionate, attentive, and timely care at an affordable cost.
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 accept 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 performed outside our office. These services should be covered under your insurance, just as they have been in the past—the facility performing the test will bill your insurance company.
Labs that we draw in our office and send to an outside lab (cholesterol panels, liver and kidney function tests, thyroid panels, 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 fingerstick blood tests—are not billed to insurance and are instead included in your monthly fee. Prescriptions will continue to be covered under your existing insurance plan. PLEASE NOTE THAT SUZANNE NORGANG, CNM, IS NOT ACCEPTING MEDICARE PATIENTS AT THIS TIME DUE TO RESTRICTIONS IMPOSED BY MEDICARE.
I have commercial insurance... can you refer me to specialists, order x-rays or labs?
For patients with PPO insurance, referrals are usually not required. For those with HMOs and strict network requirements, we can still provide referrals. The State of Maine has passed a law requiring insurance companies to honor referrals made by Direct Primary Care providers on the same terms as those made by in-network primary care providers.
You can view the legal language related to this law here:
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What if I am hospitalized?
Acadia Integrative Medicine coordinates pre-admission and post-discharge communication with the admitting physicians. Care during hospitalization is provided by hospitalists. Hospital charges and associated costs will still apply.
What if I need medical attention while I am away from home?
In the age of telemedicine, many conditions can be diagnosed and treated through a simple phone or webcam conversation. If appropriate, we will locate the nearest pharmacy and send in a prescription that best suits your needs. If you require hospital care or in-person medical attention while away, we can advise you on your options.
May I contact my provider after hours for urgent issues?
Yes. If you are experiencing an urgent issue that cannot wait until regular business hours, you may reach your provider through the patient portal or directly via her cell phone.
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Is concierge medicine the same as Direct Primary Care?
No, though these terms are sometimes used interchangeably and both are rooted in the principle of more personalized care. The terms are sometimes erroneously used interchangeably and are rooted in the same principle of more personalized attention from your doctor. With concierge medicine, the fee, sometimes upward of $2000, only provides "premium" access to the doctor. It does not cover any medical services, and your insurance or you are still billed a fee for services. Direct Primary Care clinics don’t accept insurance. They take care of most of your primary medical needs for the normal subscription fee. Direct Primary Care is a healthcare model focused on putting the patient first. That means treating them when they need it, avoiding rushed appointments, and being proactive with healthcare treatment plans. The doctor-patient relationship is just as the name suggests – direct.
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What does the membership fee cover?
The fee covers comprehensive primary care, including unlimited office visits, annual wellness exams, well-child exams, sports and school physicals, basic office procedures, treatment of acute illness or minor injuries, and direct access to your doctor—with minimal wait times.
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How much are some typical discounted lab fees?
A list of our typical lab fees is available here...
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What if I decide to cancel?
We value an open, honest, and respectful relationship. If you voice a concern that we cannot resolve together, we will gladly allow you to terminate your membership. Should you choose to rejoin in the future, re-enrollment fees may apply.
Do I still need insurance?
Yes, we recommend that you maintain health insurance. Acadia Integrative Medicine does not replace insurance coverage. Ideally, patients carry insurance for financial protection in case of hospitalization or specialist referral. We encourage you to consult with your insurance provider to select a plan that complements our care model and meets your individual needs.
What if I want to continue my current insurance? Can I still use it?
Not for services provided by Acadia Integrative Medicine. However, we can still order your labs, imaging studies, and prescriptions at any facility or pharmacy you prefer. We will work with your insurance to ensure you continue to receive necessary care outside our office.
If I have Medicare, can I join as a patient?
Currently, only patients of Dr. Seed may join with Medicare or Medicare Advantage plans.
Suzanne Norgang, CNM, cannot accept Medicare patients at this time.
For Dr. Seed’s patients: your monthly membership fee cannot be submitted to Medicare for reimbursement. However, Medicare and supplemental plans will still cover all medical expenses incurred outside Acadia Integrative Medicine—such as prescriptions, outside lab tests (including those sent to Quest), imaging, physical therapy, and hospital charges. You do not lose your Medicare coverage simply by being a patient here.
How can I save on insurance costs by being a patient of Acadia Integrative Medicine?
Many people pay high premiums for “Cadillac” insurance plans that include low or no copays, along with full lab and prescription coverage. With Acadia Integrative Medicine, your monthly fee already includes unlimited office visits and there are no copays—so it may be more cost-effective to switch to a basic or high-deductible insurance plan.
Are Acadia Integrative Medicine’s monthly fees eligible for HSA or FSA reimbursement?
Unfortunately, the short answer is no. The IRS currently views the DPC monthly fee as a “health plan,” similar to an insurance premium. If you already have a traditional insurance plan, the DPC fee is considered a second health plan and is not a qualified HSA expense.
However, in theory, if you have an HSA but do not have traditional insurance (e.g., if you are uninsured or part of a health sharing ministry), the DPC fee may be eligible for HSA spending. This is an evolving issue—please consult your insurance provider or financial advisor for personalized guidance.
Can I submit claims to my insurance directly?
Office visits cannot be submitted to insurance for reimbursement. Since visits are not billed individually but are included in your membership fee, insurance companies will not associate that fee with any specific encounter.
More importantly, insurance companies require diagnostic and procedural “codes” for reimbursement (over 69,000 options exist), as well as detailed documentation to justify those codes. This administrative burden is exactly what DPC is designed to eliminate—so your doctor can focus on caring for you.
If we haven’t fully answered all of your questions, please contact us so we can further assist you.