Direct Primary Care vs Insurance-Based Care: What Actually Changes for You | Resurgent Health

If you have been in a doctor's office lately, you probably noticed how quickly the visit ends. Fifteen minutes is often the ceiling, and much of that time is spent on documentation, coding, and prior authorizations rather than a real conversation about your health. The system was not built for that conversation. It was built for insurance billing.

More patients in Fargo are looking at a different model, one that removes the insurance middleman from primary care altogether. It is called direct primary care, or DPC, and the structure rests on a simple idea: you pay your doctor directly through a flat monthly membership, and your doctor works for you.

This article walks through what direct primary care is, how it compares to insurance-based primary care, what a membership includes, and where it fits into the rest of your healthcare. If you are wondering whether the model is worth it, or how it works in practice at a clinic like Resurgent Health in Fargo, ND, this guide is for you.

What Is Direct Primary Care?

Direct primary care is a membership-based model where patients pay a predictable monthly fee to their primary care physician. In exchange, the physician provides comprehensive primary care without billing insurance for those visits. No copays, no deductibles for office visits, and no surprise bills for a routine physical or a follow-up call.

The Direct Primary Care Alliance estimates the number of DPC practices in the United States has grown from a few dozen a decade ago to more than 2,400 today. That growth reflects a broader frustration: many doctors want more time with patients, and many patients want a doctor who actually knows them.

The core promise is straightforward. Your physician has a smaller panel of patients, so she can spend meaningful time with each one, respond to messages the same day, and coordinate the rest of your care without a billing department deciding what she can and cannot do.

The Model, Explained Simply

Think of DPC like a gym membership for your primary care. You pay a set amount each month, and in return you get unlimited access to the services covered by the membership at no extra charge per visit. Need a same-day appointment for a sinus infection? You get it. Need a 45-minute annual physical that actually addresses your goals? You get that too. The membership does not change based on how often you use it.

The clinic can operate this way because it is not spending 30 to 40 percent of its budget on insurance billing, coding staff, and denied-claim rework. That overhead gets stripped out, and the savings go into more time per visit and lower prices on labs and medications.

How DPC Differs From Insurance-Based Primary Care

The differences are not cosmetic. They touch almost every part of how care is delivered.

Billing

Insurance-based practices bill your insurance company for every visit, procedure, and lab. That triggers copays, coinsurance, and a deductible you have to hit before insurance pays anything. In DPC, the monthly membership covers your primary care visits. There is no bill after the appointment, and labs and medications are usually offered at wholesale cost, often for a fraction of what you would pay through insurance.

Visit Length

The average primary care visit under insurance is around 15 minutes, according to research published in the New England Journal of Medicine. In a DPC practice, visits typically run 30 to 60 minutes. That is not marketing. It is the natural result of a smaller patient panel and no billing paperwork eating into the schedule.

Access

In most insurance-based clinics, new patient appointments can take weeks to schedule, and same-day sick visits are hit or miss. Direct primary care practices offer same-day and next-day appointments for members, along with direct text or phone access to the physician. Instead of waiting on hold or leaving a message with a nurse triage line, you message your doctor directly.

Panel Size

A typical insurance-based primary care physician manages 2,000 to 2,500 patients. A DPC physician usually caps her panel at 500 to 800 patients. The math is simple: fewer patients means more time for each one, better continuity, and a doctor who actually remembers the details of your history.

What a Direct Primary Care Membership Includes

Specifics vary by clinic, but a well-designed DPC membership typically covers:

Same-day and next-day visits for acute issues like sinus infections, rashes, minor injuries, and colds
Annual physicals and preventive visits with no time cap
Chronic disease management for conditions like hypertension, type 2 diabetes, thyroid disorders, and cholesterol
Direct messaging with your doctor by text, phone, or secure portal, usually with same-day response
Basic in-office procedures such as skin biopsies, joint injections, ear lavage, and suturing
Wholesale-priced lab work, often 70 to 90 percent below insurance billed rates
Wholesale-priced medications for many common prescriptions
Care coordination with specialists, imaging centers, and hospitals when needed

At Resurgent Health, the membership also includes access to osteopathic manipulative therapy (OMT), a hands-on treatment approach that Dr. Martens uses for musculoskeletal issues, tension headaches, and posture-related pain. It is the kind of service that gets cut short or skipped entirely in a 15-minute insurance visit.

What Direct Primary Care Does Not Replace

This is the part that trips up a lot of people, so it is worth being direct about it. A DPC membership is not health insurance. It replaces your primary care experience, not your coverage for everything else.

You still need insurance for:

Specialist care such as cardiology, oncology, gastroenterology, or orthopedic surgery
Hospital admissions including surgery, inpatient care, and labor and delivery
Emergency room visits for major injuries, chest pain, stroke symptoms, or other emergencies
Advanced imaging like MRI and CT scans in most cases
High-cost medications that cannot be sourced at wholesale

Most DPC patients pair their membership with a high-deductible health plan or a health-sharing arrangement. The monthly membership handles the day-to-day, and the insurance is there to protect against catastrophic costs. This combination is often less expensive overall than a traditional low-deductible plan, and it comes with the added benefit of same-day access to a doctor who knows you.

Is Direct Primary Care Worth It?

The honest answer is: it depends on what you value and how you currently use healthcare.

DPC tends to make the most sense for:

Families who want a real relationship with their family physician and hate the runaround of scheduling and copays
Self-employed and small-business owners who already pay for their own high-deductible insurance and want predictable primary care costs on top of that
Patients with chronic conditions that benefit from close monitoring, quick medication adjustments, and easy communication with their doctor
People who value time and access, especially those who have struggled to get an appointment when they needed one
Anyone frustrated with rushed 15-minute visits where the doctor is typing instead of listening

DPC may not be the right fit for someone who rarely sees a doctor and prefers to keep primary care included in a traditional insurance plan. It is also not a substitute for Medicaid or fully subsidized coverage.

For most patients who do the math, the numbers work out favorably. A family of four at Resurgent Health typically pays less per month for DPC than they would in a single insurance copay for an urgent care visit, and they get unlimited access all month.

What to Expect at a Free Meet and Greet

Before you commit to a membership, we invite you to come in for a free Meet and Greet. This is not a medical visit. It is a conversation. You sit down with Dr. Martens, tour the clinic, and get honest answers to your questions, with no pressure and no obligation.

During the Meet and Greet, we typically cover:

How the membership works and what it costs for your household
What is included and what is not
How to pair the membership with your current insurance
Your health goals and any current concerns

Most people leave the Meet and Greet with a clear sense of whether DPC is right for them. Some sign up on the spot, others take a week to think about it. Either way, we want you to make the decision that fits your life.

Frequently Asked Questions

What is direct primary care?

Direct primary care is a membership model where patients pay a flat monthly fee to their primary care physician instead of using insurance for routine care. The membership covers visits, direct communication with the doctor, and often wholesale pricing on labs and medications. There are no copays for covered services and no surprise bills.

How is DPC different from concierge medicine?

The two are often confused, but they are structured differently. Concierge medicine typically charges a high annual retainer on top of billing your insurance for every visit. Direct primary care replaces insurance billing entirely for primary care services, and monthly fees are usually a fraction of concierge pricing. DPC is designed to be accessible to middle-income households, not just high earners.

Do I still need health insurance with a DPC membership?

Yes. A DPC membership is not health insurance. It covers your primary care, but you still need coverage for specialists, hospital stays, emergency care, and advanced imaging. Most DPC members pair the membership with a high-deductible health plan or a health-sharing plan, which is often more affordable than a traditional low-deductible plan.

How much does direct primary care cost?

Monthly membership fees vary by age, family size, and clinic. At most DPC practices, adult memberships range from about $75 to $150 per month, with lower rates for children and family plans. Resurgent Health publishes current pricing on the membership page so there are no surprises. Labs and medications are billed separately at wholesale cost, usually far below what insurance would charge.

What is included in the membership?

A Resurgent Health membership includes unlimited same-day and next-day office visits, annual physicals, chronic disease management, direct messaging with Dr. Martens, in-office procedures, wholesale-priced labs, wholesale-priced medications where available, access to OMT, and care coordination with specialists. See the membership page for the full list.

Can I use my HSA or FSA for a DPC membership?

The rules are evolving. Historically, monthly DPC membership fees have not been HSA-reimbursable because they are considered a fee rather than a qualified medical expense, though individual services within the membership may qualify. Federal legislation to make DPC memberships HSA-eligible has been introduced repeatedly. Talk to your tax advisor about your situation, and check with us for the latest guidance.

Is direct primary care worth it?

For patients who want longer visits, same-day access, direct communication with their doctor, and predictable costs, DPC tends to be a strong value. Families, self-employed professionals, and patients managing chronic conditions typically benefit the most. If you rarely see a doctor and are content with your current primary care experience, DPC may not add enough value to justify the membership. The free Meet and Greet is the best way to answer this question for your specific situation.

How do I switch to a direct primary care doctor?

Switching is simpler than most people expect. Schedule a free Meet and Greet, decide whether it is the right fit, and sign up. Your new DPC doctor can request records from your previous provider once you are a member, and you do not need to notify your insurance company because insurance is not paying for the membership. If you have a chronic condition or take regular medications, your first membership visit will include a full review so nothing falls through the cracks during the transition.

Ready to See What Direct Primary Care Looks Like in Fargo?

The best way to understand direct primary care is to sit down with the doctor and see the clinic for yourself. Dr. Kristine Martens, DO, offers a free, no-pressure Meet and Greet where you can ask every question on your mind and decide, on your own terms, whether the model fits your family.

To learn more about pricing, what is included, and how the membership works, visit the direct primary care membership in Fargo, ND page. To schedule your free Meet and Greet, reach out through the contact page or give us a call. We look forward to meeting you.