Everything You Need to Know About Direct Primary Care

March 21, 2025

Ever thought about paying to get basic healthcare the same way you pay for your Netflix

subscription?


It might sound unconventional, but that's a little bit of how Direct Primary Care (DPC) works. It is concierge medicine, without the hefty price tag and the need for insurance. 

The core of DPC is its affordability: making primary care services accessible to virtually everyone.


But there’s more to it than just that. This guide discusses everything you need to know about how direct primary care could change your relationships with healthcare for good.


What is Direct Primary Care and How Does It Work?


Picture this: You finally get a checkup for that stubborn cough you’ve been dealing with for the past month.


After sitting in the waiting room for almost an hour, the physician sees you for barely two minutes, gives a quick diagnosis, hands you a prescription, and leaves you with more questions than answers. 


Days later, a bill arrives—it's nearly $1,000. You're stunned, wondering if there's anything you can even do about it. 


Unfortunately, experiences like this are all too common in the U.S., where people regularly skip medical visits out of fear of exorbitant healthcare bills.


Direct Primary Care (DPC) flips this frustrating script entirely. Instead of worrying about surprise charges or rushed appointments, you pay a straightforward, affordable monthly membership fee directly to your healthcare provider.


Think of it as having a healthcare provider on retainer: you pay even during months when you don't visit, but when you do need care, there’s no hesitation or additional cost holding you back.


With DPC, you can get an appointment the same or next-day and you'll meet directly with your healthcare provider who gives you ample time and attention.  DPC providers usually spend significantly longer with patients and with appointments lasting 30 to 60 minutes (or more)
you have plenty of time to discuss concerns, review test results, or even just focus on preventive care.


Why Direct Primary Care is Worth It


Here are some key reasons why people often find value in the DPC model:


  • Predictable costs: DPC offers a straightforward monthly membership fee with transparent pricing. Patients know exactly what they're paying each month without surprise bills or hidden charges

  • Convenience and accessibility:  DPC prioritizes ease of access to healthcare providers. Patients typically enjoy direct communication with their providers through SMS messaging, in-clinic visits, video consultations, telehealth, or even house calls.

  • More time and attention: DPC providers usually have fewer patients, which gives them more time per patient per consultation. Visits last often 45 minutes to an hour.

  • Focus on proactive and preventive care: The convenience and accessibility of DPC encourage patients to be proactive about their health. Regular preventive care, timely screenings, and early interventions are more feasible when patients can easily communicate concerns without worrying about costs or availability.

  • Reduced stress and anxiety about getting care: With easy access to medical services patients often feel less stress when addressing health concerns. People no longer need to delay care due to financial concerns or lengthy processes.

  • Stronger patient-provider relationships: DPC providers take on only a small volume of patients, which means they can better understand each patient’s unique needs, history, and lifestyle, and tailor better healthcare as a result.


  • Unlimited visits:  With our monthly membership, you get unlimited visits with no co-pays—whether you prefer in-person appointments, telehealth consultations, or direct communication via email and text. This means you can reach out to your provider as often as needed, without worrying about extra costs or hidden fees. Your care should be convenient, accessible, and built around your needs.


  • Discounts on lab testing, imaging, and medication: Beyond the low-cost membership fee, DPC also helps you save on essential healthcare expenses. We offer discounts on lab test, imaging services, and prescriptions, making high-quality care more affordable and accessible.


Direct Primary Care may not fit every healthcare need or situation, but for those seeking simplicity, transparency, and personalized attention,
it offers valuable benefits worth considering.


What are the Downsides of Direct Primary Care?


Direct Primary Care isn’t without its limitations. Before you jump in, here are some disadvantages worth keeping in mind:


  • No effect on deductibles:  Your DPC membership fees won't count toward your health insurance deductible. If you face significant healthcare expenses later, such as a hospital stay or specialist visits, you'll still have to meet your deductible separately.

  • You will still need your existing insurance: Direct Primary Care typically covers routine care, preventive screenings, and minor acute illnesses. However, it doesn't cover catastrophic events, specialized treatments, major surgeries, or extended hospital stays. To remain fully protected, you'll likely need additional insurance or medical cost-sharing for these more significant health concerns.

  • Membership fees may not qualify as expenses for HSAs (Health Savings Accounts):  This limitation means you can't use pre-tax dollars to fund your DPC membership fees. However, you’ll need to check with your provider to be sure, as some of them do consider membership fees as expenses.

  • Geographical limitations: DPC providers aren't equally available everywhere, and provider choice can sometimes be limited. If you're in an area with fewer DPC options, finding the right fit could be challenging.


Is Direct Primary Care Worth It If You Have Insurance?


Yes, insurance is still important for unexpected events, catastrophic illnesses, or significant hospital stays. DPC complements your existing coverage—including traditional health insurance or Medicare—by providing convenient, personalized primary care at a predictable monthly fee.


Insurance is still recommended, but many choose Direct Primary Care (DPC) because traditional healthcare costs can be overwhelming. While it may not be a perfect solution for everyone, it provides affordable, accessible care that ensures they get the attention they need without the financial strain.


You can choose DPC alongside your insurance to balance everyday healthcare with financial protection against major medical expenses.


How Direct Primary Care Works with Medicare


Let’s say you’re enrolled in Medicare and experience an unexpected injury (like a broken bone) that requires hospitalization. Your hospital stay, specialist consultations, and advanced diagnostic testing like MRIs or CT scans and treatments would be covered under your Medicare benefits.


But for routine care, preventive checkups, minor illnesses, or regular follow-ups (services that often involve primary care providers), you could supplement Medicare by enrolling in a
DPC membership.


In short, your Medicare coverage continues to handle significant medical events and specialty care, while DPC membership supports your ongoing healthcare needs.


Can Medicaid Patients Use Direct Primary Care?


It varies by state. Typically, Medicaid policies like Colorado's prohibit providers from privately billing Medicaid patients for services already covered by Medicaid.


Since Medicaid rules differ significantly by state, it's best to contact your local social services agency or visit your state's official Medicaid website for accurate, state-specific information.


What’s the Average Monthly Cost of a Direct Primary Care Membership?


DPC memberships typically range between $50 and $100 per month for individual adults, though the cost can vary based on factors like location, provider, and specific services included. Some practices offer discounted family plans or tiered pricing based on age.


While fees can fluctuate depending on your region and the scope of care provided, most DPC memberships remain significantly more affordable than concierge medicine or traditional healthcare out-of-pocket costs. To illustrate, concierge medicine fees can cost anywhere from $150 to over $500 monthly, often in addition to regular insurance premiums.


Traditional healthcare, on the other hand, involves copays, deductibles, and hidden charges. A brief emergency room visit or appointment with a specialist can quickly escalate into thousands of dollars, especially if the patient hasn’t met their insurance deductible.


Do DPC Clinics Have Specialists?


Typically, no. However, most DPC providers maintain strong relationships with external specialists. If you require personalized care, your provider can help coordinate referrals and connect you with trusted specialists in their network. They may even assist in scheduling appointments or managing follow-ups.


What’s the Difference between Direct Primary Care and Concierge Medicine?


DPC and concierge medicine share similarities: both involve paying a membership fee directly to healthcare providers for personalized, accessible medical services. However, the main difference lies in affordability and insurance involvement.


Concierge practices typically charge premium fees, cater to wealthier clients, and often still bill insurance providers for services rendered.


In contrast, DPC aims to be accessible to a broader range of patients by offering lower monthly fees and typically does not bill insurance at all.


What’s the Difference between Direct Primary Care and Fee-for-Service?


In a fee-for-service arrangement, patients or their insurance plans pay separately for each healthcare service, procedure, or visit. It may lead to unpredictable and higher healthcare costs as patients face varying charges for each service.


This is different from the DPC model where a patient or a “member” pays a fixed, predictable monthly fee to the provider. This already grants them access to primary care services without additional charges per visit or procedure.


How Many Patients Does a DPC Provider Serve?


On average, a DPC provider may care for around 300 to 600 patients, while traditional practices often handle between 2,000 to 3,000 patients per physician. This reduced patient load allows DPC providers to spend substantially more time with each individual.


Experience a Different Kind of Healthcare


Direct Primary Care brings clarity, convenience, and personalized attention back into focus. While it may not eliminate the need for insurance, it can transform your everyday care experience by putting you in control.


Ready to experience a different kind of healthcare?
Balanced Healthcare is a Direct Primary Care clinic servicing Denver Colorado. We offer accessible primary care without the complexities of insurance. With a simple monthly membership, you get direct access to your provider, longer appointment times, and a focus on preventative care.


Interested?
Explore how to become a member of Balanced Healthcare today!

September 19, 2025
Peptides have surged in popularity as the latest trend in weight loss, fueled by social media platforms like TikTok and Instagram, where influencers and celebrities promote injections like semaglutide (Ozempic, Wegovy) as "miracle" solutions for shedding pounds. However, the buzz often blurs a critical distinction: not all peptides are designed for weight loss, and not all peptide-based medications work the same way or are even safe for this purpose. Understanding the science behind peptides and separating it from the hype is essential for anyone considering these treatments. This article explains what peptides are, how they function in the body, and whether they can truly support sustainable weight loss. What Are Peptides? Peptides are short groups of amino acids, usually between 2 and 50. They are the building blocks of proteins and serve as messengers that send signals throughout the body. They play crucial roles in regulating biological processes, including hormone secretion, immune function, metabolism, and cell-to-cell communication. Some well-known peptide hormones include: Insulin – regulates blood sugar Glucagon-like peptide-1 (GLP-1) – manages appetite and glucose Gastric inhibitory polypeptide (GIP) – stimulates insulin release Growth hormone secretagogues – promote growth, repair, and recovery Medical and Wellness Use In clinical practice, peptide therapy involves using laboratory-made peptides to mimic or enhance natural bodily functions. These therapies are most often used for: Cellular health and recovery Tissue repair Immune modulation Anti-aging and performance support While some peptides, such as GLP-1 receptor agonists (e.g., semaglutide), have shown weight-loss benefits, they are typically prescription medications developed for diabetes or obesity management, rather than general wellness treatments. Do Peptides Really Help You Lose Weight? Specific peptides, such as GLP-1 receptor agonists like semaglutide (Ozempic, Wegovy), liraglutide (Saxenda), and tirzepatide (Mounjaro), have been shown in clinical studies to aid individuals who are overweight or obese in losing weight or managing related metabolic conditions. These peptides work by mimicking natural hormones that regulate appetite and glucose metabolism. How These Peptides Work GLP-1 and GIP are incretin hormones naturally produced by the gut in response to eating. When used as medications, peptide-based GLP-1 agonists: Suppress appetite by acting on the brain's hunger centers Delay gastric emptying , which prolongs feelings of fullness Stimulate insulin release and reduce blood sugar Lower food intake Does not significantly increase energy expenditure This combined effect leads to a gradual reduction in the number of calories consumed, which aids in weight loss over time. Clinical Results Multiple studies show measurable weight loss with these drugs: Semaglutide (Wegovy) : Participants lost an average of 14.9% of their body weight over 68 weeks Liraglutide (Saxenda) : Average loss of 8% over 56 weeks Tirzepatide (Zepbound) : Participants lost up to 21% of body weight over 72 weeks with the highest dose A National Institutes of Health –funded review published in Frontiers in Endocrinology confirms that GLP-1 receptor agonists can improve metabolic markers and fat oxidation, but only when combined with dietary and behavioral interventions. Factors That Influence Weight Loss Outcomes Despite the promising data, not everyone responds to peptide medications in the same way . Several factors affect results: Baseline BMI and metabolic health Consistency with dosing Lifestyle habits (diet, exercise, sleep) Underlying conditions like insulin resistance or thyroid disorders Additionally, side effects such as nausea, vomiting, and fatigue are common during the dose-escalation period and may limit adherence. Peptide drugs do not guarantee weight loss . Clinical trials often include intensive lifestyle support (nutritionists, exercise programs), which may not reflect real-world conditions. These drugs are not a substitute for behavior change, and discontinuing them often leads to weight regain. Who Should (and Shouldn't) Use Peptides for Weight Loss? Peptide-based medications are not intended for general or cosmetic weight loss. These drugs are FDA-approved for specific patient populations and must be prescribed by a licensed physician under defined criteria. ✅ Who Should Use Peptides for Weight Loss Peptide medications are typically appropriate for adults who meet one of the following medical conditions: 1. Obesity (BMI ≥30) Individuals whose Body Mass Index (BMI) is 30 or higher , without the need for additional health conditions. Chronic diseases like type 2 diabetes, cancers, and heart problems are more likely to happen to these people. 2. Overweight (BMI ≥27) with at Least One Weight-Related Health Condition Examples include: Type 2 diabetes Hypertension (high blood pressure) Dyslipidemia (high cholesterol or triglycerides) Obstructive sleep apnea These criteria are aligned with the FDA's prescribing guidelines for GLP-1 receptor agonists, such as Wegovy and Saxenda. 3. Patients Referred by a Specialist In some cases, patients with difficult-to-treat metabolic issues may be referred by an endocrinologist or obesity medicine specialist for peptide-based interventions as part of a structured medical weight loss program. ❌ Who Shouldn't Use Peptides for Weight Loss Peptide-based medications are not suitable for everyone. Inappropriate use can result in serious side effects or ineffective outcomes. 1. Pregnant or Breastfeeding Women GLP-1 receptor agonists are not safe for use during pregnancy or lactation. Patients who become pregnant while on these medications are advised to stop immediately. 2. Individuals with a History of Certain Medical Conditions These include: Medullary thyroid carcinoma or a family history of it Multiple Endocrine Neoplasia syndrome type 2 (MEN2) Pancreatitis (active or history of) Severe gastrointestinal disorders , such as gastroparesis 3. Patients Seeking Rapid or Cosmetic Weight Loss These medications are not intended for losing a few vanity pounds. Using peptides without meeting the clinical criteria increases the risk of complications and frequently leads to weight regain upon discontinuation. 4. People Without Medical Supervision Compounded or unregulated peptides purchased online without a prescription can pose serious health risks . Non-FDA-approved products may be contaminated, underdosed, or misbranded. Peptides for weight loss should be used only by those who meet specific medical criteria, under the guidance of a healthcare provider. They are not appropriate for short-term, self-managed, or cosmetic weight loss goals, and they carry real risks for individuals with certain pre-existing conditions. Proper screening, diagnosis, and ongoing monitoring are crucial for ensuring the safe and effective use of this medication. Myth-Busting: The Truth About Peptides and Fat Loss Peptides are often marketed online as shortcuts to rapid fat loss, but these claims are misleading. There is no single “best” peptide for fat loss, and none work without concurrent lifestyle changes. There's No Universal "Best" Peptide for Fat Loss No peptide has been proven to cause fat loss in all individuals across all body types. The effectiveness of peptide-based drugs depends entirely on: The individual's metabolic profile Presence of underlying health conditions BMI and insulin sensitivity Lifestyle behaviors like diet, physical activity, and sleep Some peptides support fat metabolism indirectly by: Reducing appetite (GLP-1 agonists) Improving insulin response Enhancing mitochondrial function or cellular recovery However, these effects are secondary and occur only when the patient is already engaging in other weight management strategies. Peptides Are Not Standalone Fat-Burning Solutions Many people assume that starting a peptide injection will lead to visible fat loss without requiring any lifestyle adjustments. This is false. Peptides do not: Burn fat directly like stimulants (e.g., caffeine or ephedrine) Increase metabolic rate significantly Replace calorie control or exercise Even in clinical trials where participants lost 10-20% of their body weight, those results were achieved alongside calorie restriction and behavioral support , not just from peptides alone. Real Fat Loss Requires a Comprehensive, Personalized Plan Sustainable fat loss depends on multiple interconnected factors: Nutrition : Calorie intake, nutrient density, glycemic control Physical activity : Resistance training, cardio, NEAT (non-exercise activity thermogenesis) Sleep quality : Impacts hunger hormones and metabolic function Hormonal balance : Insulin, cortisol, thyroid, sex hormones Peptides may support specific pieces of this puzzle, but they cannot replace the foundational work of structured, personalized health planning. Final Thoughts: Safer, Sustainable Alternatives to Peptides Peptides are not a first-line solution for weight loss and should only be used when medically necessary under professional supervision. For safe, lasting results, focus on: Nutrition : Eat balanced, whole-food meals Movement : Strength train and stay active daily Hormonal Balance : Address insulin, thyroid, and other metabolic factors Sleep : Prioritize 7-9 hours of quality rest At Balanced Healthcare , we don’t use peptides as a shortcut to weight loss. Instead, we help patients build personalized, sustainable plans that address the root causes of weight gain through a whole-body health approach.
August 18, 2025
Key Takeaways Blood tests are more expensive in traditional healthcare due to facility fees, insurance markups, and unbundled billing. Insurance only covers certain lab tests and often denies coverage if the test isn't deemed medically necessary. Patients often pay for administrative overhead, duplicate testing, and delays, none of which improve the quality of care. Direct Primary Care (DPC) offers flat-fee pricing that includes routine labs at no additional cost, with no hidden charges or interference from insurance. You can save on bloodwork by asking for pricing upfront, using DPC care, and avoiding unnecessary visits or repeat testing. "Why Am I Paying So Much for Bloodwork?" The Hidden Costs of Traditional Healthcare Basic bloodwork can cost hundreds of dollars — even for insured patients — due to hidden fees, insurance markups, and unbundled billing. These inflated prices stem from the structure of traditional healthcare, where hidden fees, insurance markups, and unbundled billing practices are standard. The final cost is often unclear until the bill arrives weeks later. The good news is that more affordable and transparent options are now available. Direct Primary Care (DPC) practices, such as Balanced Healthcare, offer a flat monthly membership that often includes or significantly discounts lab work, without surprise charges. This blog will explain why bloodwork is so expensive in traditional settings, and how to avoid the hidden costs. The Sticker Shock of Traditional Bloodwork A routine blood test through traditional healthcare often results in a bill far exceeding expectations. This is primarily due to three common pricing mechanisms used in traditional systems: facility fees, co-pays, and unbundled services.. Facility fees are charges that hospitals and clinics add simply for using their space, in addition to the actual lab test cost. Co-pays may seem manageable, but patients with high-deductible plans still pay full price until that deductible is met. Unbundled billing is a practice where providers bill separately for services that could be grouped. For example, if a patient reports a symptom during a preventive visit, that visit may be reclassified as diagnostic, triggering additional charges for both the visit and any associated laboratory tests. Even with insurance, patients often pay out-of-pocket. Insurance networks negotiate rates, but not always in the patient's favor. A study in JAMA Internal Medicine found that for common blood tests like lipid and metabolic panels, insured patients still paid nearly 25% of the total cost out-of-pocket. The Hidden Layers: What You’re Really Paying For Traditional healthcare systems are often plagued by operational inefficiencies that drive up costs, without necessarily improving patient outcomes. Here’s what’s behind the inflated prices: 1. Hospital and Lab Markups Hospitals and large healthcare systems often apply significant markups to laboratory tests. A standard test, such as a lipid panel or complete blood count (CBC), may cost just a few dollars to run, but hospitals often charge patients, or their insurers, anywhere from five to twenty times more . These prices are not based on the complexity of the test but rather on the facility’s billing practices, negotiated insurance rates, and profit targets. 2. Administrative Overhead Traditional healthcare systems carry a massive administrative burden. A significant portion of healthcare spending is allocated to non-clinical functions, including billing departments, insurance coordination, and compliance staff. A Health Affairs study found that over 30% of U.S. healthcare spending goes to administrative costs — the highest rate among developed nations. These costs are indirectly passed down to patients through higher lab fees. 3. Duplicate Testing from Poor Record Sharing Patients who switch providers, use urgent care, or are referred between systems often face repeated lab tests. This is because electronic health records (EHRs) across different institutions are not always interoperable. 4. Delays That Trigger More Costs In traditional systems, patients frequently wait days or weeks for lab appointments, results, and follow-ups. These delays can result in redundant visits or additional testing if the condition worsens. Each new appointment or lab order adds to the total cost. Delayed care can also increase the likelihood of ER visits, where labs are significantly more expensive. Difference Between Traditional Care vs. Direct Primary Care (DPC) Models Traditional healthcare and Direct Primary Care (DPC) offer two fundamentally different experiences in terms of affordability, access, and billing transparency, particularly for routine services such as blood work. In traditional systems, patients must first schedule a doctor’s visit just to get a lab order. That’s followed by separate appointments, billing from multiple departments, and fees that may include co-pays, facility charges, and insurance adjustments. Billing is often delayed and can be challenging to understand. A single blood test can result in two or three separate bills, depending on how the provider codes the visit and whether insurance covers it fully. Patients are frequently surprised by costs they assumed were included or covered.  DPC removes these layers. Practices like Balanced Healthcare operate on a flat monthly membership model that covers most primary care services, including functional medicine . There is no insurance involvement, billing codes, or third-party approvals. Patients are aware of the cost upfront and can make informed decisions about their care.