There are three models of care that are typically seen in the primary care setting: Fee-for-service clinics, Direct Primary Care (DPC), and Concierge/Hybrid.

1. Fee-for-service models are your traditional clinics who take insurance. These are the places that see 1000's of people and have 20+ patients daily making it VERY busy and rushed!
2. Direct Primary Care models are clinics who have opted out of insurance. This allows the clinic to keep costs very low compared to fee-for-service clinics and allows HIGHER QUALITY in an unrushed environment. We instead charge periodic monthly fees to keep the medical provider on retainer. OFTEN, we can still order things with your insurance company for things like labs, images, and specialty referrals. The exception would be that some HMO's, including Medicaid, Oregon Health Plan, and some Medicare Advantage Plans, limit who you can choose for your care and may not approve DPC clinic orders. 
3. Concierge is a hybrid model that charges are larger more expensive monthly fee and may bill insurance as well (this is not what Resolute is).

Our membership program includes unlimited visits during business hours,  phone, text, and email correspondence with our provider, and after-hours phone or text  for urgent needs. Resolute Integrative Health offers SELF-SCHEDULING through our Patient Hub from Atlas.MD. 

Our Nurse Practitioner (NP) is available by phone or text for truly urgent matters that cannot wait until the next business day. As a reminder, we are not an urgent care or emergency room - anything that is appropriate for higher level of care will need to be seen in the appropriate setting.

Planned provider vacations are communicated in advance, and coverage is arranged to ensure continuity of care for urgent needs.

• EKG/ECG (Electrocardiogram)
• Incision and drainage of abscesses if appropriate in primary care setting
• Rapid strep and flu testing (any culture would incur additional charges). Repeated requests for tests may incur additional charges due to supply costs.
• Urinalysis (culture would incur additional charge or be sent to a lab that bills your insurance)
• Ear lavage for ear wax removal
• PAP smear collection (PAP lab pathology is billed to your insurance through Labcorp or at wholesale out of pocket additional charge)
• Well woman appts
• Cryotherapy for skin lesions (freezing of warts, etc)
• Simple laceration repairs
• Skin biopsy if appropriate (facial biopsies are not done here - lab pathology test can be billed to your insurance through Labcorp or incurs an additional charge).
• Albuterol nebulization if appropriate with wholesale cost of medication as an additional charge
• Additional procedures may be recommended based on your individual healthcare needs.  

Pricing membership fees for Primary Care Pricing are as follows:

• • $47/month for minors under 21.
  • $97/month for adults 21 and older
  • $174/month for adult married couple ($10 discount per member)
  • $297/month max for a family (parents + children of parents under 21)

Other costs:

• Estimated lab and prescription prices done in house will be provided prior to collection.
• Nonrefundable enrollment fees are $100 for each adult and $50 for each minor on an adult plan. This fee will be waived for a limited time to celebrate our fall opening.
• Wellness Add-ons (more to come)

No, definitely not.

We recommend that you always carry a medical health insurance plan as this is important to have for emergency room visits, urgent care visits, specialty care, external prescriptions, and external testing and screenings.

Resolute Integrative Health supplements your insurance with a monthly membership to RETAIN the provider to allow you easier access to quality primary care and preventative care services. This is extremely beneficial for patients with high deductibles who often avoid medical care out of fear of not meeting their deductibles.

If you cannot afford insurance, and do not qualify for state services, we recommend you look into high deductible catastrophic plans or medical share plans to offset costs outside of our clinic.

While Heather Friend DNP has 12 years of ER nurse experience, true urgent care and emergency room services are outside the scope of primary care. For emergencies, please call 911 or visit the nearest emergency room.

Resolute Integrative Health is equipped to handle simple urgent care needs during regular business hours such as colds, bladder infections, many types of skin infections, sprains, simple lacerations, etc. Some things will be directed to the urgent care or emergency if it is truly appropriate.

Do not delay emergent care if you are concerned.

We do not bill ANY insurance for services provided within the Resolute Integrative Health clinic aside from working with Labcorp to bill for labs if you choose to do that.

Any orders that we send to external businesses such as the hospital, imaging, lab, pharmacy, or other doctor's offices are typically billed through that entity to your insurance like normal. 

The EXCEPTION to being able to submit orders - People who have HMO's like Medicaid and some medicare supplemental (advantage) plans sometimes cannot get orders paid for if ordered by Non-HMO providers and doctors. You should contact your HMO servicer to see if they approve Non-HMO provider orders. In this situation, having a back up primary care provider who takes your HMO would be important to have.

For nearly all PPO private insurance plans and standard Medicare, your orders are processed through your insurance like they normally are. Heather Friend is cleared to submit orders and referrals through standard Medicare.

Resolute Integrative Health strives for QUALITY and 100% believes that cannot be done in the failed healthcare system using insurance for primary care.

Not including insurance in the clinic allows significant freedom to do appropriate and effective primary care without the pressure to order more things or see too many patients.

***Problems with fee-for-service clinics and taking insurance in primary care settings:

1. Clinics who take insurance are required to do many time consuming tasks that create further demands on both the patient and clinic.
2. Often, insurance requires outdated and non-evidence based things to be pushed onto the patient. This risks harming you as a patient. 
3. If the patient declines things the insurance wants, often the provider and clinic are dinged and risk not being paid for the visit at all. For example: A patient declining cholesterol medication or declining screening tests effects reimbursements to the clinic.
4. Insurance requirements take countless hours every day away from "direct patient care" and require an exceptional amount of time charting and coding your visit in order to be paid. Because of this, getting an appointment can be difficult and often appointments are cut short.
5. Working with insurance requires clinics to hire additional staff for billing, credentialing, and coding your visits for the insurance claims. The clinic costs to bill insurance also include fees for the middleman called national clearing houses and other credentialing companies who all take a piece of the revenue to process your insurance claim.
6. The cost to bill insurance on average takes about 50% of clinic revenue/profits. To afford these costs to bill insurance, clinics have to see large amounts of patients to keep the doors open. This means you get less time with the medical provider and wait times for scheduling are booked farther out. 

We can see Medicare but we cannot bill Medicare. We can still order and refer under basic medicare plans.

>>>For those with Medicare Advantage HMO's, you will need to contact your company and see if they allow Non-HMO provider orders to be sent to in network options.

Medicaid/Oregon Health Plan: While we can see patients with this type of insurance, we do not bill medicaid and we cannot complete referrals and other orders as we are not in network.

Those with Medicaid will need to keep a traditional fee-for-service clinic who takes insurance as a backup for specific tests/orders as their PCP.

We are happy to support specialty services regardless such as menopause treatment, men's health, and weight loss support.

This depends on how your HSA interprets our services and IRS tax code. We ARE NOT an insurance company and it is important to give a detailed explanation to your HSA what services you are receiving.

Consult your specific health saving account company for coverage. Some states do not allow HSA reimbursement for direct primary care or retainer medical practice sites.

You can use your HSA for many medical tests and costs aside from the membership per their rules.

We do not provide Super Bills for your insurance. You agree not to submit a Super Bill to your insurance if seen at Resolute Integrative Health. This is also in the contract. 

At this time, we do not carry vaccines as they require special storage temperatures and legal requirements. You can get vaccines through the local health department and most commercial pharmacies.

Nurse Practitioners are licensed to do almost the exact same thing as primary care physicians with very few exclusions that do not inhibit care. In Oregon, nurse practitioners have full independent practice authority and do not require physician collaboration. 

Things that we cannot do: 

• Order medication for assisted suicide (terminal illness with this request would be referred to someone who can support you on this matter)
• Prescribe methadone for opioid dependence
• Prescribe diabetic shoes (weird right?)
• Prescribe schedule-1 medications (this includes medical Marijuana)

The title "Doctor" is given to anyone who has a doctorate level degree. 

In medical instances, "doctor" is usually meant to describe a physician and this can create confusion for patients when other medical providers are providing primary care or other specialty services.

A physician has the letters MD or DO after their name for "Medical Doctor" or "Doctor of Osteopathic Medicine." Physicians start their education with a four year Bachelor's Degree which can be in any field (even art). If they are accepted into medical school, they then receive a four year Doctorate degree in medicine which includes everything from the basics like checking blood pressure to higher level physiology and clinics. Physicians then enter into residency in their chosen specialty which varies in length of time (typically 2-3 years for primary care). Physicians then have the option to do other fellowship training after this if needed for higher level specialty careers. 

Nurse practitioners (NP) are NOT physicians. Instead, they are a medical provider who began as a registered nurse (RN) with either an Associate Degree or Bachelor's. Some RNs start with an Associates and must receive Bachelor education to attend any NP program. Registered Nurses then can choose to get their Masters (2 year degree) or Doctorate (4 year degree) to become an NP. There education includes higher level physiology and clinicals as well. 

Nurse Practitioners receive rigorous training in their field. Their schooling time is commonly 8 years of traditional undergraduate and graduate education. Nurse Practitioners often receive additional training in their first NP job - sometimes these are structured residency programs but residency is not required.

Nurse Practitioners are required to maintain national board certification, ongoing education, and state licensing requirements. These requirements allow NP's to provide services in primary care nearly identical to physicians in the state of Oregon.

Just like physicians, NPs can opt to expand their scope of practice for further certifications and specialty education.

Resolute Integrative Health's owner and provider, Heather Friend, holds both a Master of Nursing and Doctorate of Nursing Practice degrees. She has nine years of combined degree education.

FNP - Family Nurse Practitioner. 

DNP - Doctorate of Nursing Practice

APRN - Advanced Practice Registered Nurse

Resolute Integrative Health strives to support patients in the safest long term health plan. Because of this, long term opioid/narcotic (e.g. Percocet, Tramadol, Norco), sleep meds (Ambien, Lunesta), and benzodiazepine (Xanax, Klonopin, Ativan) medications are not prescribed for ongoing daily chronic use for nearly 

Short term prescriptions for acute issues may be provided depending on the situation. If you suffer from chronic pain, insomnia, or anxiety we can help you find alternatives that are safer or we can refer to a specialist.

Heather is experienced in supporting patients get off of these long term daily medications. Patients currently on daily opioid or benzodiazepine medications will only be accepted as clients if they agree to a structured and safe taper off plan. These plans are very individualized. Heather does prescribe Suboxone for appropriate cases to assistance with opioid dependence and this would be an exception to the above for daily prescriptions.

Controlled substances are NOT carried in our clinic for distribution and are NOT offered at wholesale prices.

Other controlled substances such as testosterone for hormone replacement, sudafed for nasal congestion, phentermine for weight loss, and ADHD medications will only be provided when appropriate and after risk discussion.

Yes. We do offer virtual visits when appropriate. Any new physical complaint/symptom is always recommended to be seen in person for an exam. 

Patients who live out of state (such as California) are required to be within the Oregon boundary for any virtual visit as Heather is only licensed in Oregon.

Yes. But, you must be within the Oregon state boundary for your appointments. Heather is only licensed to practice in the state of Oregon. Usually prescriptions can be sent to out of state locations without issue. Sometimes labs can be sent to a location near you, I usually recommend an Oregon lab. 

HMO's can significantly limit your free choice for who you want to see as a patient. Choice is very important to ensure you are comfortable with your care and that you trust your provider. Without choice, you may be assigned to a place you do not like or feel like a number.

It is difficult to find specialty resources that take HMO plans because they often reimburse at much lower rates - because of this, many places are dropping HMO plans. HMO plans are more commonly restrictive of plans your Primary Care Provider wants to do and requires lots of hoops to jump through to get things approved.

Strive to have PPO plans when ever possible to avoid the above issues