Direct primary care (DPC) is a growing model of healthcare that puts patients first. DPC practices do not bill or file insurance claims; instead, the patient pays directly for the services provided through a membership model. This model of care provides freedom for both the physician and the patient, allowing physicians to have substantially fewer patients, so we can better provide highly individualized, comprehensive care. You will see your own doctor, every time. It also allows the physician and patient to focus on prevention and lifestyle to help patients achieve and maintain optimal health throughout the lifespan.

Internal Medicine is the medical specialty that focuses on the diagnosis and treatment of adult medical conditions. We provide preventative care, treat acute illnesses, and help manage chronic diseases. With our experience and training we are equipped to handle more than 80% of all adult care needs. For those who require specialists, we work closely with them to provide comprehensive care when needed. Most patients find they have less reliance on specialists when they have an internist who knows them well and is able to spend time managing their overall health.

No. As a direct care practice, we are out of network for all insurance. The monthly fee covers all services provided by Dr. Gierer. Although we do not accept insurance, insurance is still important for hospitalizations, diagnostic testing, specialist care, and medications. Many patients in direct care practices have high-deductible PPO plans, catastrophic plans, or traditional Medicare + supplement plans. We think our model is best compared to car insurance. We use our car insurance for major accidents and large expenses, not for routine oil changes and maintenance services. It is important to note that the direct primary care model is not insurance and does not meet the criteria for insurance as set forth in the Affordable Care Act.

Our current rates are: $195/mo - age 18-99 $1/mo - age 100+ More information about fees and discounts can be found here.

The state of Michigan recognizes direct primary care as an eligible medical expense but the U.S. Treasury and IRS have not officially weighed in. We advise patients with an HSA to contact their Health Plan Administrator (usually Human Resources office) and/or Accountant for guidance on using HSA funds to pay the membership fee.

Yes! We are readily available by phone, email, and secure patient portal. In most cases, if you need an in-person visit, you will be seen same-day or next-day. You will always be able to reach your doctor by phone in case of emergency, both after hours and on the weekend. We will also work to help you avoid urgent care or the emergency room if we can. If admitted to the hospital, we will help advocate for you and coordinate your care with the hospital team. All in all, direct care means that we are here for you, no matter what the health-related circumstance.

Many patients find a reduced need for specialists with a direct care internist because their doctor has the time to get to know them and manage their chronic conditions. However, we will still refer you to a specialist if needed and you may continue to see any existing specialist you choose. In that case, you will continue to see him/her using your insurance and we will work closely with your specialist to coordinate all care.

Patients may still utilize their insurance for all testing, hospitalizations, procedures, and specialist visits ordered by Dr. Gierer. Dr. Gierer will help to obtain insurance prior authorization for necessary services. Dr. Gierer has hospital privileges at Corewell/Beaumont Royal Oak. If you are admitted to the hospital she will work closely with your hospitalist physician to coordinate and advocate for your care.

​In the traditional insurance model, doctors' pay is determined by how many patients they see and how high each visit is billed based on complexity of documentation. In order for big hospital systems to make a profit, most primary care doctors need to care for a patient panel of 2500-4000 patients and limit visit to 15 minutes or less. All billing must go through insurance, requiring layers of administrative staff, leading to high overhead. In DPC, none of this applies. The physician is paid by the membership fee only. We don't bill insurance so our overhead is low. Our only financial incentive is to provide such excellent care that our patients remain members and refer their friends. We maintain a panel of only about 200 patients, all of whom enjoy direct access and the highest level of care from their physician. Traditional healthcare encourages reactionary medicine, leading to a "sick care" system. In direct primary care, we practice proactive preventative care through personalized wellness, lifestyle, and anticipatory guidance. You benefit from having a close relationship with a doctor who is there for you in sickness and in health.

We will always give advanced notice for any planned absences and the doctor will be available via telemedicine for urgent needs. If the doctor is unable to be available via telemedicine, we will arrange for a covering physician.

Primum non nocere = First, do no harm. The use of opioids/narcotics for the management of chronic pain has consistently been shown in the medical literature to worsen patient outcomes. In keeping with evidence-based medicine, we do not prescribe these medications. Rather, we will work with our patients who suffer from chronic pain to identify a personalized regimen that optimizes function and overall wellbeing. Patients who require ongoing opioids/narcotics will be referred to a pain management specialist.

There is none! Please feel free to email us any further questions at info@soundinternalmedicine.com. We look forward to speaking with you!