Frequently-Asked Questions

Why are you doing this?
What is Direct Primary Care (DPC)?
How does insurance drive up the cost of health care?
How can I afford to pay MORE for my health care?
Can the membership fee be paid for by my Health Savings Account (HSA)?
Why would I come see you if I have insurance?
Do you accept Medicare?
Can I use my insurance for labs and imaging?
How/Why did you develop this model?
What is the difference between TLC Family Health and other DPC (and what about concierge) practices?
If I join TLC Family Health, do I still need insurance?
Are there any contracts to sign? What if I decide to leave the practice?
Can I change membership levels after signing up?
Can I just do a one-time visit?

Simply put, Dr. Cluff is fully convinced that his specific model of Direct Primary Care, which he spent around six years to research and develop (and continues to tweak as needed), will transform Primary Care in a way that will fix the many problems associated with the current system.

Direct Primary Care (DPC) is a membership model of, and rapidly growing movement within, primary care that involves a direct decision-making and financial relationship between the patient and physician, eliminating the meddling, costly middlemen of insurance (including Medicare) and other parties from primary care. And yet insurance may still be used (if financially beneficial to the patient) for lab work, imaging, etc. There is a multitude of different variations, but it always involves a monthly membership fee, and hopes to improve patient outcomes at an overall decreased cost. It also usually provides extended office visits, short wait times, enhanced access, and other attractive benefits. DPC is an absolute godsend for those without insurance, and an almost no-brainer for companies who cannot afford (and aren’t obligated to provide) insurance or those who have insurance with high deductibles. If cost is the only factor (most also join because of the many Benefits), it's a little harder for those with good insurance and low deductibles (including Medicare patients) to see the value, especially if specialist care is frequently needed; however, DPC physicians believe strongly that even those folks will experience decreased health care costs over time (Medicare is currently doing several DPC pilots), because of a variety of factors, including decreased acute and emergent care visits (due to greater accessibility), decreased hospitalizations (due to improved health), and a reduction in referrals (due to more time with the physician).

Let us count the ways… The two most common ways in which insurance drastically increases health care costs are:

1. Administrative costs. A significant portion of the health care dollar - some estimate 30-40% - is spent trying to qualify for payment, bill, and collect from insurance companies.

2. Encourages unnecessary testing. We frequently make decisions to spend precious health care resources based on insurance coverage instead of true need or cost (which should be the primary reasons). Think of what would happen to fuel filters sales if we chose to have it replaced every time it was recommended during an oil change, simply because insurance paid for it (whether we needed it or not, and no matter the cost)!

It is important to further discuss “unnecessary testing.” It also involves ordering tests whose benefits do not outweigh the potential harms or costs, and/or have an unacceptable number of false positives or negatives. Unnecessary testing occurs more frequently if the provider benefits financially (often justified because patients love to be tested for things, and doctors like to learn). Sometimes unnecessary testing occurs to the point that it is outright criminal, believed by the perpetrator that it is acceptable as long as insurance will pay for it (caring more about lining their pockets than the viability of the health care system). Patients are also partly responsible, feeling that since they pay for insurance, they “might as well get [their] money’s worth.” False positives are very expensive, leading to further unnecessary tests, stress, missed work, referrals to specialists, procedures, complications, medicines, etc. The waste is staggering, and we all end up footing the bill.

Our goal is to help you spend LESS for your overall health care, allowing you to get MORE of the care you need!  To directly cover the costs, you may be able to change your insurance plan in order to free up enough funds to pay the membership fee.  In addition, you may realize savings because:

1. You are responsible for all of your health care costs below your deductible. If you spend less each year than your deductible (as most do*), you will not be spending more, and you will likely be receiving a higher level of care (not to mention all the other Benefits).

2. DPC saves you a significant amount of money by cutting insurance and other middlemen out of Primary Care and reducing burdensome administrative costs and other waste.

3. DPC allows you to get significant (usually jaw-dropping) discounts on labs and other in-office services and treatments (which are provided at cost, along with imaging and minor procedures you may have been putting off because of the price.

As such, maybe the question should be, “How can I afford NOT to sign up?” Also, it may become more palatable when you recognize that the average daily adult membership cost of less than ~$1.92/day is (often a lot) less than what you spend on other things (such as a daily latte).

Traditionally it has been felt that Health Savings Accounts (HSAs) could not be used for Direct Primary Care (DPC) monthly membership fees.  However, the reality is that DPC membership fees are not specifically mentioned as a qualified expense, rather than being specifically listed as a non-qualified expense.  In the summer of 2018, the House passed H.R. 6199, which specifies that HSAs can be used for membership fees, but we were still waiting on the Senate to pass their version. Then, on June 24, 2019, President Trump signed an executive order on health care price transparency, which included an order for the Secretary of State to establish DPC as an eligible HSA expense! As such, the answer is YES!

TLC Family Health and other DPC practices are perfect for patients without insurance, who are self-employed or self-insured, or have high-deductible or catastrophic insurance plans (and don't usually meet their deductibles). However, even if you have traditional insurance, TLC Family Health may provide you with less expensive care overall, because most deductibles far exceed our yearly membership fees, and therefore your health care dollar may actually stretch much further. If you have insurance, you may submit your expenses (other than membership fees). These will usually be reimbursed at “out-of-network” rates. Another strong consideration may be to get your preventive care (physical exams, vaccines, etc.) with an insurance-based provider, and the rest of your Primary Care with us. Lastly, we aim to provide you with enjoyable, personalized care with enhanced accessibility and communication, and a relationship of trust. You also may wish to review our Benefits and Services pages.

We see many Medicare patients, but we don’t accept or bill Medicare for payment.  Just as with insurance, continuing to accept it does not allow us to practice the way we need to in our quest to fix the system.  Medicare patients participate in DPC just as anyone else would (see Pricing – Medicare patients pay less than the 55-64 age tier), but they must complete a Medicare Contract before receiving any services – it essentially says that 1) you understand that we have opted out of, and don't bill, Medicare, and 2) that you agree not to try to submit bills incurred at TLC Family Health to Medicare for reimbursement.  Everything else works the same, and we still try to leverage your coverage for utilization of services outside our practice that will be the most financially beneficial to you. Any test or service we provide in the practice is still at cost, and will save you a lot of money if it is something that Medicare does not consider a covered benefit. It is our strong belief that Medicare would save TONS of money if they paid for DPC care (there are several pilot studies going on right now), but until then…

Dr. Cluff first learned about “retainer (periodic fee)-based” models when he was invited (in late 2011) by a concierge medicine company to go to a dinner presentation. Although he loved the idea of having extra time to spend with his patients (the income potential was also attractive), he was immediately concerned both about the cost and the fact that it would exacerbate the primary care physician (PCP) shortage. However, when he heard that such practices also had better patient outcomes (i.e., the patients were healthier), he wanted the same for his patients, and suddenly he had a new mission: To decrease the amount of time required by the physician per patient so that:

1. More patients could be accommodated, and therefore

2. The membership cost could be reduced.

And thus TLC Family Health was born. Dr. Cluff spent around six years researching and carefully developing this model (which continues to evolve as felt needed), which accomplishes the above while still hoping to provide improved care. It could be seen as a combination of various aspects of several different care models, all with the purpose of accomplishing our three-fold Mission:

1. The Ideal Medical Practice Model (among other things, it uses technology to reduce unnecessary utilization of health care resources and to streamline and improve care)

2. Lifestyle Medicine/Preventive Care Model (a major key to saving the system – 80% of the majority of diseases, including cancer, are preventable)

3. Patient-Centered/Personalized Care Model (it is all about you – communication and mutual trust are paramount)

4. Team-Based Care (team members practice to the top of their training, freeing up the physician to address those things for which he/she is needed the most – also remember that you are an active member of the team)

5. Group-Based Instruction (more efficient and often more effective)

6. Direct Primary Care/Discount Membership Model (facilitates the above and our Mission)

DPC practices are growing in popularity almost exponentially (there were around 140 DPC practices in 2014, and now there are over 1700 – and growth will be even more exponential once I prove my concept), felt by us DPC physicians to be the answer to the majority of what is ailing Primary Health Care in America. Most DPC practices advertise unlimited care for the monthly membership fee, and therefore are 1) usually a little more expensive, and 2) usually have smaller patient panels than TLC Family Health. TLC Family Health is also different from most in that we offer two different plans, and provide services with our Physician Assistant(s) at a discounted rate. Remember that all DPC practices run a little differently, with several similarities (CLICK HERE for a nationwide map of DPC practices). Concierge practices are the most expensive type of “retainer” medicine, and usually also bill insurance. They usually provide an even higher level of care (including extensive “executive” physicals and spa-type services) and therefore have the smallest patient panels. Many DPC practices around the country offer discount medicines; unfortunately, Texas law forbids doctors from dispensing their own medicines. TLC Family Health may also differ in that we offer Group Visits, discounted mental health counseling services for members, and an innovative scheduling system.

Yes. We try to provide as much of your care as we can (usually >85-90% of your health care needs), and to reduce your need for specialists, urgent care, hospital stays, and higher-cost medicines (consider a prescription discount program such as Blink Health or Scriptco, or use GoodRx to find the cheapest cash-pay prices). However, we strongly encourage you to carry a catastrophic plan for expensive health care needs we cannot fulfill. We recommend a Health Cost Sharing Plan as a companion to Direct Primary Care (DPC) practices such as ours, especially Sedera, Zion Health, and Christian Healthcare Ministries. Also CLICK HERE for a comparison table of nine of the most common ones, courtesy of Ochna Health, another DPC practice.

There are no contracts to sign (just review the Patient Agreement), and you may leave the practice at any time.  However, we charge a new registration fee each time you re-enroll.

You may downgrade once. As you might imagine, DPC practices would not be able to survive if patients were able to change plans whenever it benefited them financially, e.g., changing to the Gold Plan to be able to see the doctor several times in one month at the cheaper copay, switching to the Silver Plan once the need was met, back to the Gold when needed, and so on.

Dr. Cluff used to offer a one-time visit option for those who, for example:

1. Were just in town visiting

2. Were leaving the area

3. Only needed a second opinion

4. Were simply not ready for a long-term relationship or new Primary Care Physician (i.e., those who just wanted to "try" Dr. Cluff out before committing).

Because only 40- and 60-minute visit options were available for one-time visits, the cost was $200 and $300, respectively. Over time Dr. Cluff realized that those options in reality cost more than actually joining his practice for 1-3 months (depending on age) in the case of a 40-minute visit, or much longer in the case of a 60-minute visit! Since there are no contracts to sign (you may cancel at any time), and since joining the practice facilitates follow-up care – which was not included with the one-time visit option – it made no sense to continue to offer it! Feel free to contact us if you have any questions.

*Accessed April 26, 2020 at https://www.americanactionforum.org/weekly-checkup/most-exchange-enrollees-will-never-reach-deductible/