At Three Peaks Pediatrics and Lactation, our mission is to make healthcare simple again, and that includes how we handle billing. Our Direct Primary Care (DPC) model is fundamentally different from the traditional insurance-based system, designed to eliminate confusion, surprise bills, and the red tape that often stands between you and your doctor.

The core of our DPC model is a flat, predictable membership fee. This fee is paid directly to our practice, bypassing insurance companies entirely for our primary care services. This means:

• No co-pays or deductibles for routine check-ups, sick visits, or follow-up appointments.
• No confusing Explanation of Benefits (EOB) forms to decipher after a visit.
• No more short, rushed appointments dictated by insurance company reimbursement rates.

By removing insurance from the equation for our in-office care, we are free to focus on what matters most: spending quality time with your child and building a strong, trusting relationship with your family.

While we don’t bill insurance for our in-office services, your health insurance remains a crucial part of your healthcare plan. We use it to get you the most cost-effective rates for services that fall outside of primary care.

• Labs and Imaging: When your child needs blood work, an X-ray, or other diagnostic imaging, we’ll send the order to an external lab or imaging center. They will bill your insurance directly for these services, just as they would with a traditional practice. Your insurance benefits (like a deductible or co-pay) will apply here.
• Specialist Referrals: If we determine your child needs to see a specialist, we will make the referral for you. The specialist’s office will then bill your insurance directly for their services, ensuring your benefits are utilized.
• Medications: When we prescribe medication, we send the prescription to your pharmacy of choice. The pharmacy will bill your insurance directly for the cost of the medication, applying any co-pays or deductibles based on your plan.

Our approach allows us to deliver high-quality, personalized primary care with transparent pricing, while still helping you leverage your insurance for the more expensive, complex services. It’s the best of both worlds: clear, affordable primary care and the security of knowing your insurance is there for everything else.