Pricing

SIMA Plans cover visit fees, direct communication with your doctor (via phone, text, or e-mail), and care coordination without copay. We do not contract with insurance companies (hence, direct primary care), so we can keep the cost of routine healthcare low and quality of care high. Forgoing insurance payments removes the costly intermediates of processing and billing insurance claims that drive up the cost of healthcare. Removing these intermediaries and directing private contracts with our patients give both parties the ability to have valuable visits. This decreases the total cost of healthcare by avoiding the expensive, down-stream effects of urgent care and emergency room visits, excessive testing, and unnecessary specialty referrals.

Participating in integrative DPC addresses health at the ground level and avoids accessory healthcare expense. As a result, reductions in insurance premiums can be appreciated. According to a Forbes article, “An independent academic reviewer looked at claims data and found that patients in a direct primary care practice...had 25% lower outpatient utilization, 48% less ER visits, and 41% fewer hospital admissions than patients in a matched control group. This translated into a 12.3% net lower total cost of care...”^[1]

SIMA Plans are not insurance, but are complementary and flexible plans to various insurance policies (including private plans, health shares, Medicare, Medicaid, and/or HSA/FSA accounts) or to those who do not have insurance. Your eligibility to be part of SIMA is not hinged on insurance status, although it is advisable that patients maintain an insurance plan for catastrophic coverage. Insurance will be utilized to cover the costs of labs, imaging, prescription medications, specialists, and major medical events including hospitalization. However, if you choose not to use your insurance, or do not carry an insurance policy, SIMA provides discounted-cash price labs, imaging, and prescription medications. SIMA Plans are not tax deductible at this time, as they are not classified as “medical expenses” by the federal government. However, you can submit your SIMA medical bills to your insurance company for potential reimbursement (excluding Medicare and Medicaid, as these entities require insurance contracts for reimbursement).

^[1] Chase D. Direct primary care: Value proposition, scope of practice and pricing. https://www.forbes.com/sites/davechase/2013/07/08/direct-primary-care-value-proposition-scope-of-practice-and-pricing/?sh=4a69bcf95ada. Published July 8, 2013. Accessed February 5, 2021.