Capitol Hill Medical

(206) 720-9999 Phone
(206) 329-4444 Fax
901 Boren Ave Suite 705
Seattle, WA 98104

Capitol Hill Medical Direct Primary Care

Our mission at Capitol Hill Medical has always been to provide the best primary and preventive care to the LGBTQ population of Greater Seattle as well as our straight cisgender friends and allies. Since we were established in 2008, we have been proud to maintain lasting therapeutic relationships with our patients, while providing personalized, culturally fluent care. In recent years, we have noticed that many patients have to enroll in insurance plans that prevent them from being seen by our providers. Insurance companies continue to reduce payments in order to boost profits. The doctor-patient relationship seems to be irrelevant to these decisions, and both doctors and patients are worse off for it.

CHM Direct is our attempt to re-prioritize and strengthen provider-patient relationships. It is our version of Direct Primary Care (DPC), which is a new model of healthcare delivery. Unlike traditional practices, DPC providers work outside of the insurance industry when providing your care. Because patients are paying providers for their care directly, they are not beholden to insurance rules and requirements, nor are they subject to arcane and complex billing practices that almost always end up with the patient paying ever-increasing and unexpected charges. Providers are not buried under meaningless paperwork and documentation requirements, and can focus on their patients rather than the computer screen. In removing this interference from insurance companies, we are freed to provide the excellent care you have become accustomed to, and our therapeutic relationships with you can flourish.

What’s Included in CHM Direct?

Primary Care

  • Office visits with no copays or fees
  • Virtual care (through Patient Portal or telephone)
  • Preventative visits
  • Chronic care management (diabetes, high blood pressure, asthma, etc)
  • Urgent same or next day appointments
  • Gender-affirming hormone therapy and monitoring
  • PrEP prescription and monitoring
  • HIV care
  • STI screens
  • Pre-operative clearance
  • Acute visits
  • And more...

Procedures

Included in membership (pathology/lab costs will be supplemental):

  • Joint injections and/or aspirations
  • Trigger point injections
  • Skin biopsies
  • Mole and skin tag removals
  • Cryotherapy with liquid nitrogen for warts and other skin lesions
  • Ear lavage
  • Simple laceration repairs
  • Incision and drainage of abscesses
  • EKGs
  • Contraception management
  • Pap smears

Questions

What is Direct Primary Care (DPC)?

DPC is healthcare delivery model that focuses on prioritizing the patient-doctor relationship. In DPC, the provider bills the patient directly. By removing interference from insurance companies, we’re able to put your needs first. For a flat, age-based monthly fee, you get covered office visits with no copays, direct access to your doctor by phone, portal messaging, same day or next day visits, unrushed office visits, and discounted labs, pathology, and imaging, all without the need to use insurance. The price for your care at CHM is transparent with no surprise costs from deductible or coinsurance that you learn about after the fact.

Are your services covered by my insurance?

No. Your insurance will not cover this monthly DPC subscription. The purpose of the DPC model is to remove the “middleman” of the insurance company, which is ultimately beholden to the demands of shareholders rather than the needs of their customers. DPC removes all of the uncertainty around cost of primary care services - that guessing game of how much you’ll have to pay after a doctor’s visit. Most primary care labs, pathology, and imaging will have established wholesale prices. You can still use your insurance for those services.

Should I still have insurance?

Absolutely. Direct primary care is primary care only - the services we can deliver to you through our clinic. You’ll still need coverage for those services we don’t provide, such as emergency care, hospitalization, long-term care, diagnostic imaging, labs, and specialist referrals.
It is important to think carefully about your healthcare needs, and whether you should carry a more affordable high deductible catastrophic plan or a more expensive higher coverage plan. The advantage of DPC is that you’ll already have paid your DPC provider for all your primary care needs.

I have insurance. Can I still sign up for DPC?

Currently, patients with private healthcare plans that CHM currently contracts with may not sign up for DPC, as our contracts with those companies prevent us from offering DPC services. Patients with the following plans, however, may sign up:

  • Apple Care plans
  • Tricare
  • Molina Healthcare
  • Medicare
  • Medicaid
  • Uninsured patients (though we highly recommend having some form of health insurance)
  • Kaiser Core (not Kaiser PPO)
  • Premera (ONLY the plans that restrict you to UW-only or Virginia Mason-only providers)

Please note that Capitol Hill Medical will continue to bill insurance for primary care services for the following plans:

  • Aetna
  • Blue Cross/Blue Shield - most plans
  • Cigna
  • Kaiser (Access PPO/First Choice Health Network plans only)
  • Lifewise (through Premera)
  • Premera
  • Regence
  • Tufts Health Plan
  • Uniform (through Regence)
  • United Healthcare (employer based group plans only)

If you have any of these insurance plans, you are not eligible to enroll as a DPC patient.

Can I use my HSA/FSA to pay for services?

You probably cannot use your Health Savings Account/Plan (HSA/HSP) to pay for membership fees at this time, but this may change in the future. A Flexible Spending Account (FSA) can be used on what your employer deems appropriate when setting this service up, so talk to your Human Resources or your employer about this. Both types of accounts can be used for labs, imaging and medications.

What does the CHM Direct Subscription Cost?

CHM Direct subscription costs vary by the age of the patient. You can opt to be billed per month or annually.

Age Range Monthly Cost
18-29 $99
30-39 $119
40-49 $139
50-64 $159
65+ $189

How might I save money by paying a monthly fee for CHM Direct?

Participating in CHM Direct may or may not save you money. Here are some ways that people have saved money using Direct Primary Care:

  1. Decreased monthly health costs. If paired with a low premium, high deductible insurance plan, the premium money you save might be much greater than the monthly membership fee for primary care. Still, you will need to envision different scenarios of out-of-pocket costs for medical care you receive from parties other than Capitol Hill Medical, PLLC.
  2. Less time away from work and family. Under the CHM Direct model, you can optimize the amount of care we provide you via electronic means. Fewer trips to the clinic means less time away from work and family.
  3. Fewer surprise bills from insurance companies. With CHM Direct, you know up front how much you are paying for primary care. No more guessing whether the office visit will be billed at a level 3, 4, or 5, if an appointment for a given topic will or won’t be covered under your insurance plan, or what your out-of-pocket cost will be for an office procedure.

Once I join CHM Direct, may I terminate my membership?

Yes, at any time and for any reason, but you must provide written notice to CHM (email or through the Patient Portal will suffice). Monthly fees will be prorated to the date CHM receives your written termination. Importantly, you will not be allowed to rejoin CHM Direct until one complete calendar year from the date you discontinued your membership. Re-establishing as a CHM Direct patient will require a reinitiation fee of $275.00.

Can CHM terminate my membership?

Yes, but not solely on the basis of your health status or protected status. Per RCW 48.150.050, “…the direct practice may discontinue care for direct patients if: (a) The patient fails to pay the direct fee...; (b) the patient has performed an act that constitutes fraud; (c) the patient repeatedly fails to comply with the recommended treatment plan; (d) the patient is abusive and presents an emotional or physical danger to the staff or other patients of the direct practice; or (e) the direct practice discontinues operation as a direct practice.”

Can Capitol Hill Medical decline to accept me in into CHM Direct?

Yes, per RCW 48.150, a direct practice may decline to accept a patient “if the practice has reached its maximum capacity, or if the patient’s medical condition is such that the provider is unable to provide the appropriate level and type of health care services in the direct practice”.

How do I sign up?

It's easy – just call the front desk and tell them you'd like to sign up for Direct Primary Care and we'll take care of the rest!