FAQs

Short answer: It’s a 15-minute free appointment with me, Dr. Hayley Moak-Blest. This is not a medical appointment. I’ll use this time to answer questions you have about the DPC model, my practice philosophy, the specifics of my practice, and questions around insurance.

(Vitality Family Medicine does not bill insurance, I am a direct pay/private pay doctor. But patients still have insurance and want to use it when it benefits them. See other FAQs below for more details, and I can answer any other insurance questions when we meet).

Long answer: I’ll also use this time to briefly learn what’s not worked for you in the traditional system to ensure your needs and expectations can be met by Vitality Family Medicine.

This appointment is focused on highlighting the transparency of the DPC model and Vitality Family Medicine and ensuring you have a clear understanding of the practice and my approach. If you’re interested, you’ll be given information at the “Meet & Greet” on how to sign up to become a member. Scheduling a Meet & Greet is non-binding. Preferably, the Meet & Greet is in person so you can experience the relaxed environment where you’ll be receiving your care.

Short answer: Doctor of Osteopathic Medicine. There are two types of med schools in the US, allopathic (MD) and osteopathic (DO). Both have the same rigorous admission requirements and curriculum. Both produce physicians that practice modern day American medicine in any specialty.

DOs are holistic. It’s such an overused word, but it’s the word that explains DOs, especially those of us who actively use Osteopathic Manipulative Therapy (OMT) in our practice (there aren’t many of us who actively use OMT). I’ll tell you why and how I use it below. Sneak peek: it’s about aiding the body to heal itself.

Big Picture: As an osteopath, when I’m diagnosing and problem solving, I’m always thinking about the whole person and how EVERYTHING in the body is connected; the mind, outer structure/musculoskeletal system, the inner organs, circulatory system, pulmonary system, infection-fighting lymphatic system, nervous system, etc. It’s all connected, and a problem in one location or system will have an effect on the other locations/systems.

Treat the Problem, Not the Symptom: Back to Osteopathic Manipulative Medicine. In addition to more traditional Western treatments, I use a complementary form of medicine, called OMT to help remove/treat dysfunction to help aid the body in healing itself. For example, if someone has pneumonia, I give them antibiotics and an inhaler as indicated, but I also treat their ribs so that their lungs can expand more efficiently and oxygenate the blood better. I also do lymphatic techniques to improve the flow of infection- fighting lymph to and from the lungs. I also use OMT to treat the thoracic spine in order to inhibit sympathetic (fight or flight) nerve outflow to the lungs, which will help open the airways and improve oxygenation. Pretty cool, huh?

Probably. Remember, I’m a DO, and always thinking about how that outer you (musculoskeletal system) interacts with the inner you (mind, organs, circulatory system, etc). So at a bare minimum, I will show you exercises (often derived from simple yoga postures) or breathing techniques that will help address whatever medical issue you are facing. Though I will be easily accessible, I won’t be treating you daily, so with simple home exercises you can mimic what I do with OMT.

Short answer: I’m human. It could happen. If I get a communicable disease (COVID, flu, bad cold, stomach bug) and I’m worried about infecting you, I will switch scheduled appointments to telehealth or delay them a few days. Rescheduling patients for this reason is easy because I will NOT be overbooking myself. Remember, accessibility is the foundation that the Direct Primary Care model is based on, so there will be plenty of room on future days for you to receive in-person care once I’m well.

Long answer: If I cannot see you in person on a day I’m sick and you have an urgent need, I will direct you to local urgent care services. As long as I’m not bed ridden, I will be available by phone for urgent matters. If you do need to use urgent care, I would be able to contact them directly about your issue and make your medical history available to that clinic. If I have a serious illness that lasts longer than a few days, I will arrange your care to be handled by another direct primary care doctor. Because I always want to be healthy and here for you, I will be requiring masks during visits for the foreseeable future in order to avoid/minimize instances of this sick scenario.

For URGENT matters I will be available by phone, evenings and weekends. I have small children and value my own health by getting outside and being active, so you may get a VM or text response that I will be getting back to patients in a couple of hours. If the matter cannot wait, then it is an Emergency, not an Urgency, and you should seek emergency medical attention. When necessary, I will make myself available for after hours/weekend telehealth and in person visits whenever possible. I love Newburyport and purposefully chose an office close to home so I can be accessible to patients. The reality is, I make access as easy as possible during the week and during business hours, so patients rarely need to get in touch with me after hours. That being said, things happen after hours that cannot wait until the next business day, but may not require the Emergency Room. For this reason, I check voicemails on the weekends once in the morning, midday, and evening.

Short answer: I will give my patients 1-2 month forewarning before I go on vacation with my family or travel for continuing medical education.

Long answer: I will provide multiple reminders so patients can schedule appointments before I leave. While traveling, I will be available by phone for URGENT matters that cannot wait for my return. There may be a few days or a week in a year that I am not available, and patients will need to use the local urgent care.

We recommend all routine pediatric vaccines recommended by the American Academy of Pediatrics & Center for Disease Control. Vaccines are important tools in preventing vaccine-borne illness. I get routine vaccines for myself, as does my family. Vaccines do more to prevent vaccine-borne illness than they cause harm. That said, no patient will be excluded from the practice for failure to comply with my recommendations. I will speak with each family that has vaccine hesitancy and address individual questions with answers based in science, while acknowledging that our emotional selves play a large role in decision making.

Patients need to treat staff and fellow patients with respect regardless of their background and cultural beliefs. The practice is all welcoming, this includes all political views, genders, ethnicities, skin colors, ages, partner choice, and occupations. Patients who are not respectful of other patients and staff will have their memberships terminated.

Short answer: No. Direct Primary Care (DPC) is not a form of healthcare insurance. However, choosing to become a DPC patient of mine at Vitality Family Medicine will change how you think about buying and using conventional healthcare insurance, the amount of insurance you will need, and the value you get for your total healthcare spend.

Long answer: I strongly encourage all my patients to carry health insurance to cover unexpected critical illnesses—accidents that require acute care at a hospital—or the need to see a specialty or subspecialty doctor. While my patients carry some conventional healthcare insurance as a backup for these extraordinary situations, they typically find their DPC relationship with me covers 85-90% of their medical needs. Most importantly, they find personalized primary care with me more satisfying. Say goodbye to deductibles, copays, and doctors in a rush. And, say hello to getting more for your healthcare dollars.

Short Answer: Yes. However, Vitality Family Medicine will accept you as a patient no matter what insurance you have.

Long Answer: If you have a healthshare (such as Sedera), Medicare, HMO insurance, PPO insurance, or no insurance at all, you will be accepted by the practice as a patient member. The reason why the answer to this question is Yes, is because from the patient perspective, some insurances make it easier for patients to get their care from a DPC doctor. PPO plans, traditional Medicare and Health Share plans do not make you choose an “in network” primary care doctor, so you can see whomever you wish for primary care. I am fully licensed and dually Board Certified, but have CHOSEN not to be constrained by insurance contracts so I can work for you, the patient, in the best way I know how without having to adhere to the dictates of an insurance company. Thus, I will never be considered in- network.

This matters to you because if you need a referral to a specialist, that referral may have to come from an in-network doctor. If you have further insurance questions please “Read On.”

Read On: As it stands by law in Massachusetts right now, HMOs require In Network Referrals. On the federal level, Medicare Advantage plans have the same requirement. The laws in other New England states have changed regarding this matter, but for now, this is the case in Massachusetts. But, there is a work around. Patients with HMO plans can switch to PPO plans or they can stay on their HMO, choose an in network doctor, establish care with that doctor in case we ever need a referral to a specialist, but come to Vitality Family Medicine for regular care.

Our patients choose to do this because the Fee For Service model they are subjected to in the typical HMO or PPO office cannot deliver the same level of accessibility and attention as I can give you. Not because the doctor in the practice doesn’t care, but because the Fee For Service insurance based model just does not make it possible.

Lastly, if you have a PPO with a high deductible, DPC is really a great option for you because we NEVER bill insurance for care delivered within the walls of DPC. So if you need office-based procedures, OMT, regular follow up for chronic disease management, bloodwork, etc—all of the things many insurance policies will not cover until you hit your deductible—or only 80% of until you hit your deductible—you won’t be paying extra because your membership with my office covers all of those services.

If you do not have insurance, you may still become a member.

For patients without insurance and patients contemplating different insurance, I can help guide you to more affordable health insurance options that allow you to continue enjoying the Vitality Family Medicine experience in the DPC model.

Short answer: I will order imaging as medically necessary and guide you to the most affordable location to have imaging performed often the local hospital if you have low deductible insurance, but some independent imaging centers offer more affordable imaging for the uninsured or those under insured with high deductible plans.

Long answer: If your medical care is complicated or complex and a consultation with a specialist is needed, I will recommend a doctor to see and communicate with that specialist directly regarding why we need the consultation.

If you have insurance that requires the referral to come from your in-network “assigned Primary Care Physician (PCP),” I will communicate the reason for the referral to your assigned PCP. The PCP may require an appointment in order to process the referral, but doc-to-doc communication often expedites such appointments and they have physician extenders that can take on these simpler appointments (we would have already done all of the work up and hard part so placing a referral is easy). But, alas in the Fee for Service insurance-based world, it often requires an appointment.

Short answer: There is no additional “office visit” charge for our appointments, and there never will be.

Long answer: Whether you’re sick or healthy, having a membership means no “cover charge” at the door. We feel that sometimes extra charges like these may discourage people from seeing their doctor (or encourage them to wait until they’re a lot sicker to do so), and we really want to eliminate barriers to good care wherever we can.

There are some very specific exceptions, and because transparency is so important with DPC, exceptions are listed below.

• Home visits: $100/visit. Only available for patients who live within 10 miles of the practice

• Osteopathic Manipulative Therapy (OMT) visits incur additional fees of $75 per visit, as this is a specialty care service offered at my primary care practice. However, as a matter of practice, I do use OMT for many sick visits, in which case there are no additional fees. Up to 3 OMT visits per year are free, this allows all patients to receive periodic OMT included in their membership. I want to make OMT services available to patients who require frequent treatments, but I'm mindful that it limits access to me for other members. Charging additional fees for patients that require regular specialty osteopathic manipulative treatment allows me to maintain my accessibility for all in the practice.

• Labs drawn and specimens taken at the office are offered at extremely discounted prices ( 1/10 of insurance prices). Patients are required to pay lab fees at the time of service. If you want to bill your insurance company, you may do so, but almost always this ends up costing you more.