What is Direct Rheumatology Care?
How the model works, what it includes, and what it doesn't.
I work for you, not the insurance company.
That one sentence explains most of how this practice runs. There's no third party deciding how long we get to talk, what counts as a billable problem, or whether the thing you came in for fits the visit. It's you and me.
The way that works is simple. You pay me directly. No copay at the desk. No bill arriving two months later for an amount nobody warned you about. You know the cost up front, and then we do the medicine.
There are two ways in, and they're different.
Start with a consultation
Most people come to me with a question.
Do I have rheumatoid arthritis? My ANA came back positive, does that mean something? My hands hurt every morning and nobody can tell me why. My primary care doctor found something and wants a rheumatologist to look at it.
The consultation exists to answer that question. Which kind you need depends on what you're bringing me.
A comprehensive consultation runs up to 90 minutes. This is where most people land. It's for a broad or unclear picture: widespread joint pain, a positive ANA nobody has explained, a possible autoimmune disease, a long history that needs untangling. I take your full history, examine you properly, and review your prior workup, including any available labs and pertinent imaging.
A focused consultation runs up to 45 minutes. This is for a single, defined problem. One joint. Gout. Osteoporosis. Something with a narrower question attached to it.
Both include a 15 minute follow-up phone call once your workup is complete, so we can go through the final picture together. You won't be left reading a lab result in a portal at 9pm trying to figure out what it means.
You don't need to join anything to be seen for a consultation.
And plenty of people stop there. Sometimes the answer is that you don't have an autoimmune disease. But that's rarely the end of it, because something is still causing your symptoms, and you deserve to know what. Often it's osteoarthritis, or hypermobility, or fibromyalgia, or something mechanical that's been misread for years. Those are real and they're treatable.
Some of that I can tell you the same day. Some of it takes a workup first. Fibromyalgia is a good example, because before I land on it I want to be confident we've ruled out what else it could be. That's what the labs and the follow-up call are for. Either way, you leave with a direction, and you get a real answer once the picture is complete.
For a lot of people, that's the whole story. If the problem is clear and you and your primary care doctor can carry the plan from here, I'll tell you so, and we're done. I'd rather send you out with an answer than sign you up for something you don't need.
Other times, the diagnosis is worth ongoing work. Fibromyalgia again. It's a real condition with real treatment, and it responds to a careful approach over time. What it doesn't respond to is a rushed appointment. When I was practicing in insurance-based care, I didn't have the time to do it properly, and most rheumatologists don't. That's not a knock on anybody. It's what a full schedule does to you. Here, I have the time. If you want ongoing help with a musculoskeletal concern, I'll do my best for you, even if it technically isn't an autoimmune disorder.
Membership is for ongoing care
Some questions don't close in one visit.
If you're newly diagnosed with something that needs treatment, monitoring, and adjustment over time, that's a relationship, not an appointment. If your disease is active and changing. If you're starting a medication that needs watching. If the picture is complicated and there are still open questions.
Or, as I said above, if you have something like fibromyalgia, where the treatment really is time and attention.
That's when membership makes sense.
Membership is a flat monthly fee, and there are two tiers.
Active Care is where most new patients start. Five or more visits a year, at 45 minutes each. It's built for a new diagnosis, or disease that's active and needs regular adjustment, or a complicated picture with open questions.
Maintenance Care is for disease that's stable and under control. Up to four visits a year, at 30 minutes each, where we're monitoring rather than chasing.
Either tier includes:
Ultrasound. When it's useful, I do it myself, right there in the visit, and I show you what I'm seeing.
Joint injections and aspirations. Done in the office, with ultrasound guidance when it's needed.
Routine monitoring labs. The standard bloodwork we follow on your medications, including CBC, CMP, ESR, and CRP.
Direct messaging. You message me, not a call center. I read it and I answer it, including on weekends.
Care coordination. When you need imaging, a surgeon, or another specialist, I help arrange it and stay involved.
If you start in Active Care and your disease settles down, we move you to Maintenance. That's the goal.
What direct care doesn’t include
Direct care is not insurance. It doesn't cover a hospital stay, surgery, an MRI, an emergency room visit, or biologic medications, which can run thousands of dollars a month.
So you keep your insurance. Direct care sits alongside it. Your insurance handles the large and unpredictable costs, which is what it's built for.
Direct care and concierge medicine are not the same thing
In most concierge arrangements, you pay an annual retainer and the practice still bills your insurance for your visits.
Direct care removes the insurance billing for the care I provide. What you pay is the full cost of that care. Nothing else is running in the background.
That's what makes the pricing clear. I can tell you exactly what your care costs, because there's no second invoice on its way.
Why any of this matters
The whole model comes down to one decision: I keep a small panel on purpose.
That's what buys the 45 minutes. That's what leaves room in the schedule when something changes and you need to be seen. And it's why, when you send a message, I'm the one who reads it.
Every price is listed on the site. You'll know the number before you commit, and it won't move.
If cost is a barrier for you, say so. I'd rather have an honest conversation about it than have you quietly decide you can't be here.
Have a question you want answered? Schedule a free virtual meet and greet, or email me at drmiller@restorerheumatology.com.
