Thank you Megan

Medicare + DPC (important legal clarification) This is a critical Medicare law issue, so here’s how it actually works — not how people wish it worked. If you have not formally opted out of Medicare, you cannot privately charge a Medicare beneficiary for covered services, even one time, even if you are non-participating. Key Medicare status distinctions: Participating provider - Accepts Medicare assignment - Bills Medicare - Accepts Medicare-allowed amount as full payment Non-participating provider - Still enrolled in Medicare - May bill Medicare or the patient - Must still submit a Medicare claim - Limited to the limiting charge (115%) - Cannot privately contract - Cannot charge arbitrary cash rates Non-participating ≠ cash practice. Opted-out provider (required for DPC/cash practices) - Files Medicare opt-out affidavit - Uses Medicare-compliant private contracts - Does not bill Medicare - Opt-out lasts 2 years (auto-renews) This is the only legal path for DPC + Medicare patients. What you cannot do (even once): - See a Medicare patient and charge cash - Skip submitting a Medicare claim - Call it “integrative” or “wellness” to bypass Medicare - Assume it’s okay because it’s only one patient Medicare does not care if it’s one visit or one hundred. If you see this patient before opting out, you must: - Treat them as a Medicare patient - Bill Medicare-covered E/M services - Submit a CMS-1500 claim - Follow limiting-charge rules - Use ABNs appropriately If you don’t know how to submit a Medicare claim, that’s a strong sign not to see the patient yet. Best practice for DPC / integrative clinics: - Delay seeing the patient - File your Medicare opt-out affidavit - Use a compliant Medicare private contract - Then see the patient legally as cash/DPC Bottom line: If you haven’t opted out of Medicare, you cannot privately charge a Medicare patient — even once. Opt out first, then proceed.

@Sara Modlin Really appreciate the honesty here—and you’re not wrong at all. Your experience is exactly why so many DPC practices (INCLUDING OURS) get burned by Zocdoc. Paying for leads that aren’t a fit is frustrating, especially when margins and time matter as much as they do in DPC. Where our thinking started to shift wasn’t around liking Zocdoc (we honestly don't like it)—it was around patient lifetime value vs cost of acquisition. If you look at Zocdoc purely as “paying for every lead,” it almost never makes sense. But if you step back and ask: - What is the lifetime value of a patient who actually stays? - How many months of membership does it take to cover acquisition cost? - Can we filter hard enough up front to avoid delivering care to the wrong patients? …then the conversation changes. We don’t see Zocdoc as a marketing channel or a relationship platform. We see it as a top-of-funnel discovery tool that has to be OUTSMARTED. For us, that meant: - Aggressive expectation-setting immediately after booking - Clear automation explaining exactly who we are and who we’re not - Encouraging early cancellations for misaligned patients - Requiring payment before care - And being okay with saying “this isn’t a fit” on both sides You’re also right to point out the mechanics: Zocdoc doesn’t charge for cancelled appointments—but it does charge for no-shows. That’s where unfiltered funnels get expensive fast. So rather than pretending Zocdoc is good or bad, we’ve tried to ask a different question:Can we design systems that protect our time, our staff, and our model—while still capturing the occasional long-term patient who would never have found us otherwise? Totally fair if the answer for some practices is still “no.” Our goal with this post was less about saying “use Zocdoc” and more about opening an honest discussion around how people think about acquisition, fit, and lifetime value in DPC. Really appreciate you engaging directly—this is exactly the kind of real-world perspective that makes this community valuable. ❤️

We have looked at Klarity too, haven’t pulled the trigger yet