Members FAQ

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Hey everyone, I’m your virtual guide to your new health plan and I’m here on behalf of Neer and Angel today to break down some common questions about your DPC health plan.

Choosing the right plan and understanding how it works can feel like navigating a medical maze, right? We’ve all been there. That’s why we’ve put together this FAQ session to give you clear, simple answers and help you feel confident about your healthcare.

So, let’s dive right in and demystify your DPC.

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Thinking of seeing a specialist? Wait, don’t make that call just yet. Before you rush to see a specialist, there’s one crucial step you can’t skip. Call, text, or email your Virtuous Benefits Healthcare Advocate.

Why? To help you schedule the visit with zero hassle and full cooperation from the front desk.

Our healthcare advocate team is here to help. They’ll coordinate with the specialist, arrange payment, and make sure you’re covered. So before you pick up that phone to book an appointment, dial, text, or email up your Virtuous Benefits Healthcare Advocate.

We’ve got your back, ensuring a smooth and stress-free experience. Take the guesswork out of your healthcare. Call us first.

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Lab work. Save money with your DPC provider. Here’s the deal with lab work. When your DPC provider orders a lab test, they’re fully covered under your plan. No extra cost to you.

But if a specialist or another doctor orders the same test without your DPC’s knowledge, you might get hit with unnecessary out-of-pocket expenses.

My advice, keep your DPC in the loop. If another doctor wants you to get lab work, let your DPC know. They can often order the same test, saving you money and potential headaches. Have questions?

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What’s covered under your DPC plan? This DPC plan has you covered when it comes to your medical needs. But what about dental and vision?

Don’t worry, you’re all set. You’ll have separate dental and vision plans to take care of your pearly whites and those precious peepers. Remember, prevention is key, so schedule those checkups.

We’re here to help. Just call, text, or email your Virtuous Benefits Healthcare Navigator.

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Do I need a referral to see a specialist?

Great question. I’m glad you asked. The short answer is no. You don’t need a referral. But before scheduling an outside appointment, it’s wise to talk with your direct primary care doctor first.

Direct primary care doctors are trained to care for the whole person. They focus on comprehensive relationship-based care to help you stay healthy. Often, what seems like it might require a specialist can be handled quickly and competently by your DPC.

Of course, specialists are important for complex or serious issues, but your direct primary care doctor is your first line of defense. They help you stay well, catch things early, and ensure any next steps are in your best interest.

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Keeping your trusted specialist. Already seeing a specialist for an existing condition? Good news. You don’t have to switch doctors. Whether you’re on the DPC or non-DPC plan, you can keep your current specialist. Just let Virtuous Benefits know who you’re seeing so they can ensure everything goes smoothly. But let’s get your DPC doctor in the loop. They’re there for your whole health experience. And you know, it’s a second opinion at no extra fee. You’re going to want them to know everything that’s going on with you.

Since your DPC is your home foundation for health, your DPC will work with your specialist to support your care. That’s the whole goal, supporting you on your wellness journey.

So, call, text, or email your virtuous benefits care navigators. They’re here to help coordinate care and make sure you always have a clear path forward.

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Understanding your deductible. Let’s talk deductibles.

Regardless of which plan you’ve chosen, you still may have a deductible. This is something you’ll want to understand clearly.

In simple terms, your deductible is the amount you pay out of pocket before your insurance kicks in. That being said, almost anything your DPC does or ask for is covered by your plan with no out-of-pocket costs.

However, for services outside of your DPC, such as hospitalizations, outpatient procedures, surgeries, or anything ordered by your specialist, your deductible will apply. Once you’ve hit your deductible, your insurance will start covering a larger percentage of your medical costs.

Have questions? Call, text, or email your Care Navigator.

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So, getting reimbursed, here’s how it works. If you pay out of pocket for a medical expense, make sure to hang on to your receipts. To get reimbursed, you’ll need a copy of your payment receipt, plus a detailed itemized statement from the provider. This helps the insurance company understand what the payment covered.

Call, text, or email your Virtuous Benefits Care Navigator for help with the reimbursement process. They’re here to make the process as smooth and stress-free as possible so you can focus on your health, not the paperwork.

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While your plan outlines co-pays for specific services, other costs outside your DPC like lab tests, images, scans, or outpatient procedures can vary quite a bit depending on the provider or facility. That can make it hard to know what to expect.

In the past, your traditional health plan kept you in the dark. Costs were hidden from you; somehow though, you always got a surprise bill. That’s exactly why you rely on Virtuous Benefits. They consistently turn on the light in an often confusing system, helping you understand your options, avoid hidden costs, and make informed choices with confidence.

When you contact them, they work behind the scenes to ensure you won’t get ripped off. They use a fair multiple of Medicare to pay providers. They aim to keep prices low and reasonable. Most facilities actually prefer a cash price since they get paid right away.

And if something costs more than it should, they’ll step in and negotiate on your behalf so you’re not stuck with a surprise bill or paying more than necessary for the same quality care.

Regardless which Virtuous Benefits plan you’re on, Virtuous Benefits is here to help you estimate your costs in advance so you can plan ahead with clarity and peace of mind.

As always, call, text, or email your Care Navigator if you have questions.

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That wraps up our DPC health plan FAQ session. Stay healthy and informed. We hope this information helps you feel more confident and empowered in managing your healthcare.

If you have more questions, call, text, or email the amazing team at Virtuous Benefits. They’re your partners in navigating healthcare. Remember, knowledge is power, especially when it comes to your health.