Frequently Asked Questions

Direct Primary Care

  • While sounding somewhat new, Direct Primary Care (aka “DPC”) is a movement in Family Medicine that actually is more similar to the way health care used to be. Instead of the fee-for-service model, where you may be charged copays and office visit charges, direct primary care uses a simple membership model to cut down on wait times, remove obstacles, and allow you to spend time with your doctor, both in person and online. It’s a simpler approach to care, so that you can get what you need, when you need it.

  • We call our practice "concierge-style." Regular concierge medicine typically still bills insurance for each visit, but charges an additional fee on top of insurance for access to the doctor. Our boutique practice is different in that we provide that high-touch service, but without the extra billing of insurance. We keep things simple and transparent with a monthly membership. Patients are still welcome to use their insurance for labs, imaging, referrals, and other outside services.

Our Physicians

  • A DO is a Doctor of Osteopathic Medicine: a fully-licensed physician who is able to practice in all specialties of medicine—just like an MD. In addition, we receive special training in the musculoskeletal system, so that we can diagnose and treat many common illnesses with the use of OMT, or Osteopathic Manipulative Therapy. We also receive training that focuses on prevention and taking into account how lifestyle and environment can impact disease. Christina and I are DOs, and Dr. Ailene is an MD. Whether MD or DO, all Defiant doctors are committed to holistic, hospitality-forward care.

  • Yes. Christina and I are both fully licensed through the Commonwealth of Virginia and board certified by the National Board of Physicians and Surgeons (NBPAS). Dr. Ailene is also fully licensed, and board certified by the American Board of Family Medicine (ABFM).

  • It depends what you mean by “specialize.” For clarity, we’re distinguishing between specialists (e.g. Cardiology, General Surgery, Pulmonology) and generalists (e.g. Family Medicine, Pediatrics, Internal Medicine). Generalists are designed to handle a very wide range of problems, and specialists are designed to be experts in a particular field or organ system.

    Now, if you just mean, “do we have any particular interests in medicine?” then yes, we absolutely do. We place special emphasis in our practice on Longevity Medicine, advanced cholesterol analysis, menopausal hormonal therapy, and weight loss, all from a wellness-first, holistic perspective. But any new treatment or skill we learn is designed to broaden our scope of practice, rather than narrow it. We’re trained to provide 85-90% of the care that people typically need in their lifetime, and we truly enjoy building that relationship with the members of our community. We like being able to help out with as many concerns as possible.

    Sometimes, though, when we’re asked if we intend to specialize, what someone actually means is, “are you sticking around for the long haul?” The answer: we love being Family Medicine doctors, and we have no intention for that to change. The community we serve as Family Medicine docs is the secret sauce in our lives; it’s what gets us up and excited in the morning. When it comes to giving people the best care possible, we’re all in.

  • No, and thank goodness for that. The little-known secret in most health systems is that there’s a lot of pressure from pushy suits for family medicine docs to keep patients “in the System.” They may refer you to Surgeon A because that surgeon is in their health system, when Surgeon B outside the system is the foremost expert on treating that condition. We know amazing specialists from all over, and because we don’t have affiliations, we’re free to make a tailored recommendation for the perfect specialist when needed.

    When that happens, our expert care navigators allow us to go in-between health systems, preparing the way and connecting the dots for you, ensuring you have access to the absolute best team for the job.

Insurance

  • Your membership is for your primary care needs, but it’s not the same thing as health insurance. We recommend (but don’t require) our members obtain health insurance to cover more expensive health care needs, which can be done with things like a high-deductible catastrophic plan or more robust insurance plans, too.

  • We don't. We do not bill insurance, or contract with any private or public insurance plans. This allows us to keep the pricing of our services transparent to our members. You can still use your insurance for other medical practices, pharmacies, and hospital visits. You can also use insurance for your labs, imaging, and medications as well. However, we are able to negotiate directly with many vendors from these companies to offer exclusive pricing on these services to our members. Some patients prefer not to bill their insurance for these as a result.

  • No worries. You don't need insurance to be a member with us. We recommend having insurance for emergencies and other needs, but we don't require it, and we don't bill insurance companies for our services. In addition, to make sure our members are getting the highest value, we contract directly with vendors to provide exclusive pricing for labs and other services.

  • The short answer: Drs. Jake, Christina, and Ailene can all see patients who have Medicare or who are Medicare-eligible.

    The long answer: Medicare, unfortunately, has severe regulations regarding DPC practices that limit our ability to provide the best possible care. So, in order for us to see a patient with Medicare, we "opted out" of the standard Medicare contract. As a result, when a patient with Medicare sees us, rather than billing or claiming reimbursement from Medicare for the services we provide, we instead enter into a private, simple agreement with the patient, which spells out how our practice works. Patients can still use Medicare for their medications, specialists, hospital visits, emergencies, labs, imaging, etc., but just not our monthly membership. This simple and direct relationship is designed to give the highest-quality care--without all the insurance strings attached.

The Membership

  • The monthly membership fee allows us to provide you with the absolute best care imaginable. With this model, we're able to spend extra time with our patients: focusing on their concerns, and really dialing in to not just treating disease, but going over preventive strategies, before problems strike. We spend over an hour with patients at their first visit, talking about how to best tailor a plan to their needs. We also find that when the office isn’t stuffed to the brim with seven-minute visits, you can be seen when you need to be seen, without the wait.

  • In a world where Dr. Google does a bang-up job creating needless anxiety, we believe it’s important to have a trusted doctor in your corner who knows you—someone who can take the time to help you find the best solution for your needs.

    Having a doctor you can reach via text, phone, email, video, and in-person visits means we can be proactive, and get things squared away before your problem becomes a problem. That surprise sinus infection or unexpected issue can be taken care of earlier, meaning less hassle and fewer trips to emergency department. Even better, there’s no waiting room involved.

    We also know life gets a little busy sometimes. For the things that slowly creep up on you over the years, it helps to have someone working behind the scenes to prevent disease decades down the road, so you can focus on the here and now.

    Finally, we place an emphasis not just on treated disease, but on optimizing wellness. We’ve got the best jet lag protocol. We know how to craft an incredible diet, build better habits, and get you the best sleep of your life. Our goal is to help you meet your goals, short term and long.

  • Not at all! We love building lasting relationships with our patients; that's one of the big reasons we enjoy Family Medicine so much. But the most important thing for patients everywhere is to have a good fit with their doctors. If you feel like that's not us, just let us know. There are no tricky long-term commitments. You can unsubscribe as a member at any time.

  • Don't worry, there are no shady deals, we promise. Our goal is to provide as much value to you as humanly possible. To that end, we've negotiated directly with the lab companies and other suppliers for exclusive pricing for our members. When it comes to medical tests, we don't like anxiety and guesswork, either.

  • We get this a lot. There is no additional “office visit” charge for our appointments, and there never will be. We think things are simpler this way. (It’s kind of like a certain online video streaming service, where you only keep a membership, and are not charged for each time you watch a movie). Whether you’re sick or healthy, having a membership means no “cover charge” at the door. We’re happy to eliminate the hassles of health care, wherever we can.

  • The current medical culture has exorbitant, hidden pricing everywhere, because why not. Rest assured that we don’t do that. For starters, we believe part of informed health care is patients generally knowing how much things are going to cost, upfront. If we’re doing a procedure in the office, any rare, nominal fee (on the order of $5 to $10 or so) is designed to cover the cost of the materials themselves, like syringes or the actual medicine being injected. The vast majority of these services are rolled into the membership and included at no additional charge. Have a medical reason for an EKG? Your membership already takes care of that. We think this makes for better care.

Our Practice

  • Yes! Having a medical condition before you see us won’t change your eligibility or our membership price.

  • Decades ago, patients would be seen by their own family medicine doctor while in the hospital. But as hospital systems have become more regulated and complex, there are now dedicated “hospitalists”—doctors who work exclusively in the hospital and don’t have an outside clinic. When you’re sick enough to need the hospital, it makes sense to have a doctor who does nothing but hospital medicine. Still, we want to make sure that doctor has all the information needed to make the best decisions. As a result, as advocates for you while you're in the hospital, we touch base with your care team frequently over the course of your stay, and also talk to you to answer any questions you might have about how things are developing. That way, when you come out of the hospital, we know exactly what’s been going on, and can get you back to your regular regimen again.

  • We don't do prenatal/pregnancy care or obstetrics in our practice, but we can get you connected with fantastic OBGYNs and additional resources in our community. Also, we don't prescribe chronic Schedule II medications like opioids or amphetamines. Your membership also doesn't cover things done outside our office, like hospitalizations/surgeries, or specialist visits.

  • Ah, yes. “Defiant” for a medical practice is a little unusual—just like us. We think the current health care model could use a change of pace, and so we chose a name that really jives with our goal of doing something different to make health care a better place all around. As for the bird (AKA the "Defiant Jay"), we wanted something that represented the feeling of not being caged in anymore, and I think that's something doctors and patients can both relate to.

  • Absolutely not! Many of our patients are on a myriad of diets. WFPB eating is a great way to prioritize fresh fruits, vegetables and whole grains, but it is by no means required. We personalize nutrition goals for each individual patient.

  • Great! We’re currently accepting new members. To get started, simply click the link below or the “Sign Up” button at the top right of the page, which will take you to our registration page.

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