Frequently Asked Questions

Question: Do you accept my insurance?

Answer:

We do not accept any insurance. However, we do accept you! We quit taking insurance so that we could give patients more time and not cram you into a 10-15 minute slot where you get 5-10 minutes with the doctor. Since this is a Direct Primary Care practice we are limiting the practice size to around 500 patients per physician. A traditional practice generally has around 2,500 patients per physician and in some cases, 4000-5000 patients per physician.

We charge a membership fee, $960 a year for an individual, broken into monthly payments of $80. Membership includes all your office visits and many in-office procedures. We invite you to checkout our membership page for details.

Question: Why are you doing this vs a traditional practice?

Answer:
  1. Direct Primary Care allows physicians to spend more time with patients than a traditional practice. The smaller panel size (500 vs. 2500+) affords each patient more time with their doctor and allows them to be able to be seen when sick.
  2. Insurance is great to pay for unexcepted & costly events. However, health insurance is not timely health access. Many practices accept insurance but will book out for weeks to months. With DPC, when you are sick or hurt, you can be seen the same day or next business day.
  3. Generally speaking, primary care is fairly predictable and most things are really not expensive when you drill down to the actual hard costs. See our lab and generic medication pricing...most common meds & lab tests are between $4 and $12.
  4. DPC brings the sacredness back to the doctor-patient relationship. When using insurance, the physician is required to provide information to your insurance company in order to receive payment. This data can then be used against you in the future. Our electronic health record is secured for your privacy. Your data stays with us and is only shared at your request. (to specialists, life insurance companies, etc)
  5. In most traditional practices these days, physicians no longer have any say in their office staffing, processes, etc. We believe we get what we pay for. We will not employ the lowest cost personnel we can find. We only want employees that actually care about our patients and can do their jobs well.
  6. Transparent pricing on generic medications and labs and flexiblity in what we offer. If you have a medication or test you would like that's not on our list, just let us know and we'll see if we can you get a price. Insurance won't pay for a test just because you want to know the results. Want to know your blood type, measles imunity, or something else that might not be covered? We'll get you a cash price.

Question: Why should I join? I have great insurance.

Answer:
  1. Because time is valuable and we do our best to not waste yours!
  2. Waiting weeks or even months for an appointment is counter productive for everyone. When sick, we can take care of you the same day or next business day. Not every ailment needs an office visit.
  3. Insurance is great for things like hospitalizations and major illnesses, but for basic primary care and typical illnesses and injuries, most patients can save a lot of money by not going through their insurance company. Using health insurance for a sinus infection or blood pressure monitoring would be like using car insurance for an oil change. There is no need to pay a car insurance deductible for oil changes.
  4. We can actually save many patients money with our in-house pharmacy and low cost labs, even those who think that they have really good insurance.
  5. Your insurance may not pay as much as you think. We have found that people think they are better insured than they actually are in most cases. We have transparent pricing. If we don't have a price for something, we can get one for you.
  6. You are an individual and real person to us, not just a medical record number. We actually care.

Summary: Time, Convenience, & Save Money

Question: What is covered?

Answer:
  • You’ll get a yearly thorough physical with age appropriate testing (full body skin exam, breast exam, pelvic exam, prostate exam, etc).
  • Chronic disease management for diabetes, high blood pressure and a host of other medical ailments.
  • In-office procedures such as skin lesion removal, abscess drainage, ear wax removal, nebulizer treatments, steroid injections, cryotherapy, EKGs.
  • Same or Next day sick visits.
  • Extensive access to your personal physician via text, email, phone, and video visits.

Question: Does anything cost extra?

Answer:

McGilligan MD tries to be as inclusive as possible with our professional services however there are some low cost extras at times. Any services not performed by McGilligan MD are not included. Medications and adminstering medications (B12 shots, Testosterone, etc) are done with an additional fee. These fees are minimal and we make the patient aware of the cost before hand.

Example: If you have a pap smear or a skin biopsy, our physicians do not charge for the procedure, but there will be a charge for the pathologist to look at the samples under a microscope and give a report.

We offer lost cost labs (most common labs are between $4-$12) for those who want the labs billed to our account. Imaging can be ordered at a local imaging facility that offers competitive pricing as well. Of course you can always choose to use your insurance for labs and imaging.

Question: Is this an insurance plan?

Answer:

Absolutely not. However, membership can give you a peace of mind that your doctor is available when you need her.

It also allows you to know that you’ll always be able to access your personal physician, not an unknown doctor on call. With membership, we will see you the same day or the next business day, so you won’t have to wait weeks to be seen or end up in an urgent care.

Question: Do I have to have insurance?

Answer:

No. McGilligan MD Physicians will see you as a patient even if you don’t have insurance. The membership fee covers all of your visits and insurance is not billed.

It is still a good idea to have a health insurance policy for unexpected emergencies and expensive events such as surgeries.

Membership in a direct primary care practice allows you to receive high quality primary care to best keep you healthy.

Question: I'm healthy. Why would I want to pay a monthly fee if I don't see the doctor every month?

Answer:

Even when healthy, having a personal physician allows you to focus on preventing disease and maintaining wellness.

When was the last time you had an in-depth preventative wellness visit? We can help with nutrition counseling, physical exercise, and mental health. You’ll know that you have a doctor at the ready if you get a sinus or bladder infection. And with our in office pharmacy, you can leave the office with your prescription in hand, skipping the lines at the pharmacy.

Whether you’re traveling or you’re home here in Cincinnati, when you have an acute problem we’re here for you! And best part is – no wait times and same-day/next-day visits!

Getting ready to travel internationally? We can use telemedicine to help solve most medical problems while you’re abroad. Never again do you have to worry about finding an urgent care or wondering about a provider’s skill level.

Think of the monthly membership fee as a way to help cap your medical expenses.

Question: What if I need to see a specialist?

Answer:

We will try to treat as many things as possible ourselves, but sometimes a patient may need to see a specialist.

Our physicians are local to Anderson and will refer you out to a great local physician specialist.

If you don’t have health insurance, our doctors can speak with the specialist about pricing. If you do have insurance, the specialist can bill your insurance company.

Question: What if I have to go to the hospital?

Answer:

We all hope to never have to go to the hospital, but sometimes it is necessary.

McGilligan MD Physicians are currently not seeing patients while they are in the hospital, but will communicate with the hospital physicians, obtain records related to your hospitalization, and see you quickly when you get out to help get you back to health and keep you there.

Question: What happens if I am out of town and get sick or hurt?

Answer:

This is a great question. Since we have multiple ways of communication, we can frequently help you while you are out of town with either phone calls, email, text, or video conferencing visits. There is also a network of Direct Primary Care physicians in other areas of the country whom we can contact and try to get you in to be seen if your injury or illness requires it.

Question: Can I use my HSA or FSA to pay the monthly fees?

Answer:

It appears that for now, you cannot. There are bills in congress currently to help patients be able to use an HSA or FSA card to pay for their monthly membership fees. If you choose to use your HSA or FSA card for fees, we recommend you verify this with your accountant or financial advisor.

Question: How many patients is each doctor going to have?

Answer:

We limit the practice size of each physician to 500 patients.

Just for a frame of reference traditional practices no longer accepting patients have around 2,500 patients.

McGilligan MD Membership

Membership Overview

  • You will benefit from direct communication with your doctor via phone, secure text and video visits.
  • While McGilligan MD doesn't accept insurance, it is still recommended for hospitalizations, surgeries, etc.
  • You can also still use your insurance for labs, imaging, and medications at any facility you choose that accepts insurance. 1
  • All office visits are included in the monthly membership fee. See the pricing page for details
  • Many common in office procedures are included in membership.
MCGILLIGAN MD, INC.’S DIRECT PRIMARY CARE PRACTICE IS NOT INSURANCE. PATIENT ACKNOWLEDGES AND UNDERSTANDS THAT MEMBERSHIP IN THE DIRECT PRIMARY CARE MODEL DOES NOT PROVIDE HEALTH INSURANCE COVERAGE, A HEALTH INSURANCE POLICY, A HEALTH BENEFIT PLAN, NOR IS IT A CONTRACT OF INSURANCE. MEMBERSHIP IN THE DIRECT PRIMARY CARE MODEL IS NOT AVAILABLE TO KENTUCKY MEDICAID ENROLLEES.
Footnotes: 1 Given your plan doesn't require in-network referrals. Only required by plans like Medicare HMOs where in network referrals from in network doctors are required. PPO and similar plans do not have this restriction. Please check with your insurance company if you are unclear about the details of your plan.

Online Scheduling

Please note this is only for existing members of the practice. If you are not an existing member, you will need to register and complete all of our onboarding packet before your appointment. Otherwise, your appointment will be cancelled.

What does Membership in the Practice Mean?

  • You will be charged $80 a month per individual. This monthly fee allows patients to have easier access to their physician. It includes all visits including in office, phone, and video visits. You also get longer than average visits with your physician. Family Pricing is also available.
  • You will benefit from direct communication with your doctor via phone, secure text and video visits.
  • While McGilligan MD doesn't accept insurance for office visits, it is still recommended and can be used for hospitalizations, surgeries, specialists, labs, vaccines, etc.
Checkout our FAQ & Pricing pages for more detail.