Why some Tarrant doctors are choosing to forgo insurance to offer membership-based care

Why some Tarrant doctors are choosing to forgo insurance to offer membership-based care

Melissa Hamiton, 44, has never had great experiences with primary care doctors.

As a mother of four, she recalls taking her sick children to clinics and spending hours of the day in the waiting room. By the time doctors were available, they would only spend a few minutes in the exam room before moving on to their next patient.

The short time with her children’s doctor was frustrating and also made her feel like the money her family was investing in insurance was being wasted, she said.

“Having insurance is expensive,” Hamiton said. “My husband is a veteran, so he’s covered, but just for me and my four kids who are still at home, it’s up to $1,400 a month without the primary care portion. That’s just astronomical.”

Nothing has changed for years.

Hamilton’s family continued to use insurance until they discovered something new: direct primary care.

Through the direct primary care model, private practices choose not to accept insurance plans and instead require patients to pay a monthly fee to receive primary care services. Instead of going through third-party billing, patients pay fees directly to the doctor.

Although the model is relatively new, it has seen exponential growth in the past six years with more than 1,400 practices in the United States, according to a 2021 study by the National Library of Medicine. There are currently over 20 direct primary care practices in Tarrant County, according to DPC Frontier.

More people, including Hamilton, are opting out of paying for insurance plans and instead choosing clinics across Tarrant County that are using the growing health model. For physicians, direct primary care offers a new side of clinic ownership that they haven’t seen before.

To find a direct primary care practice in Tarrant County, Click here.

‘Needs are taken care of’

Dr. Kara Farley has always been unhappy with the disconnect between patients and their primary care physician. When she decided it was time to start her own practice, she knew she wanted to offer something different.

“The reason I went into medicine was to have a relationship with my patients and provide that quality of care for them, and with the 15-minute patient model, you’re not able to do that,” she said.

Through extensive research, Farley discovered direct primary care through the Facebook group Real Physician Moms of DFW. She was able to meet a physician who was successfully running her own practice with the care model.

The model opened Farley’s eyes and she jumped to her feet, she said.

Farley opened Mid Cities Direct Primary Care in Grapevine in January 2021. Monthly practice fees range from $50 to $100 per person, depending on age, with a one-time fee of $150 to join. The practice is not currently accepting new patients, according to the Mid Cities website.

As members, patients have unlimited access to Farley and the other doctors on her team. During appointments, doctors are able to spend more time with each patient instead of rushing to see another one since there’s not a quota to meet, Farley said.

“When patients started coming here, they saw the difference in the quality of care they received,” Farley said. “They usually get an appointment from an hour to an hour and a half. We go through their entire history. We cover everything that needs to be covered in one visit.”

Mid Cities had 50 patients in the first six months. Since then, the practice has grown and now serves more than 750 patients in North Texas.

In early 2021, Hamilton was introduced to Mid Cities Direct Primary Care by her husband. Upon hearing about the low membership fees, Hamilton was shocked, but immediately intrigued enough to join the practice.

Hamilton signed up and now pays $400 a month for her entire family to receive primary care from Farley. The clinic has changed her life, she said.

“All of our needs have been taken care of,” Hamilton said. “I can call (Farley), I can text her. I texted him at 3am because I had a baby with a fever and was in full panic mode. … I’ve been a mom for 26 years and I’ve never had an experience as good as this.”

The direct primary care model is also filling a gap for people who can’t afford to pay for insurance but also don’t qualify for health assistance programs, said Dr. Alex Vilaythong, founder of Enlightened Health Direct.

Dr. Alex Vilaythong is a board-certified family physician and founder of Enlightened Health Direct in Arlington. It offers monthly membership packages, ranging from $39 to $95, for people to get primary care. (David Moreno | The Fort Worth Report)

“Many patients do not have health insurance, but they qualify for JPS or Parkland benefits because of excess income,” he said. “You’re talking about a $1 that disqualifies you. … I wanted to cut through the middleman, which is health insurance.”

Like Mid Cities, Enlightened Health Direct also offers primary care services, but its monthly fees range from $39 to $95, depending on the person’s age. Since its inception in 2022, Enlightened Health Direct has grown to serve over 130 patients throughout North Texas.

‘Hard to compete’

As direct primary care clinics begin to gain popularity, there are several challenges to overcome. There is a lot of skepticism from patients about committing, and that can affect the success of a practice, Vilaythong said.

“When you come out of residency, these big hospitals try to recruit you and give you a good salary, and it’s hard to compete,” Vilaythong said. “It’s hard to turn that down and say, ‘No, I’m going to go out on my own and start my own practice, I’m going to start from patient zero and hope that one person will pay me.’ This is what is really scary (direct primary care).

Although direct primary care helps keep her children healthy, Hamilton worries in the event of a major hospital emergency. Without insurance, medical bills can pile up. Hamilton said she and her husband are considering an insurance plan with a high deductible for emergencies, often known as catastrophic coverage.

But Hamilton believes that keeping her children healthy reduces the chances of an emergency, and that there are more benefits to staying on her membership plan than leaving it. She believes that direct primary care is revolutionizing health care.

“I told my husband I would rather not have the insurance plan than lose Kara,” Hamilton said. “She is much more accessible. She is my friend now. I don’t just see him as my doctor. I feel this is how health care should go.”

David Moreno is a health reporter for the Fort Worth Report. His position is supported by a grant from Texas Health Resources. Contact him at [email protected] or @davidmreports on X, formerly known as Twitter.

At The Fort Worth Report, news decisions are made independently by our board members and financial supporters. Read more about our editorial independence policy here.

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