What is Direct Primary Care or "DPC?"

 

Direct Primary Care (or DPC for short) is a medical clinic/practice model that simplifies the currently complex healthcare system. For a practice to qualify as a DPC, the practice must charge a periodic fee and not bill any third parties (such as insurance) on a fee for service basis. By cutting out these middlemen, Direct Primary Care providers are no longer influenced by insurance or hospital/medical group administrators to nickel-and-dime each office visit to pay into a large healthcare system. Instead, the monthly membership fee allows your medical provider to spend more time with each patient to get to the heart of what is medically necessary for each person without any surprise large bills being sent to you. Also, care is more personalized in a DPC due to the reduced number of patients/members in a clinic.

​

Do DPC clinics accept health insurance?

 

No. DPC clinics do not accept health insurance nor submit documentation to insurance companies for reimbursement to the clinic. It is still recommended to have insurance or alternate medical expense coverage for larger (aka - "catastrophic") events such as conditions requiring one to go to the Emergency Department or have surgery.

 

In addition to traditional "catastrophic" insurance, there are faith based and non-faith based, voluntary, healthcare cost-sharing ministries and communities that are acceptable options to meet the individual mandate for health cost coverage in the Affordable Care Act. They include:

 

Sedera Medical Cost Sharing Community, www.sedera.com  (855) 338-2831,

Liberty HealthShare, https://libertyhealthshare.org (855) 585-4237,

Samaritan Ministries, www.samaritanministries.org (888) 268-4377,

Christian Care Ministry www.mychristiancare.org (800) 772-5623, and

Christian Healthcare Ministries, www.chministries.org (800) 791-6225.

 

Please research all your options for additional management of large healthcare costs.

 

Why should I pay a fee in addition to my insurance for medical care?

 

Unfortunately, you already pay more through most insurance plan compared to what you would with a Direct Primary Care clinic and any form of coverage for larger medical expenses. As insurance premiums continue to increase, more individuals, families and employers seek low-premium, high deductible insurance plans. This equates to paying an insurance premium, a co-pay for each office visit, expensive lab/procedure bills and expensive medication co-pays. And that's just for your Primary Care coverage! With Direct Primary Care, you typically can get more for your healthcare dollar through one monthly fee that is less than most cell phone bills.

 

Can I use my HSA/HRA/FSA to pay for your monthly fees? Are monthly fees tax deductible?

 

Currently, it is recommended that you check with your CPA or financial/tax advisor regarding use of your HSA/FSA funds for your monthly membership fee or attempting to claim a deduction for these fees.

 

What if I need to see a specialist?

 

Your DPC provider can make referrals to specialists just like any other primary care doctor and each office will have more time to follow-up on your visits with specialists to ensure your needs are met in the most efficient and expedient way possible.

 

What if I'm hospitalized?

​Many DPC providers may not have any affiliation/privileges with any area hospitals but will be in contact with you, your family and your hospitalist to remain aware of your situation while you are in the hospital. Upon your leaving/discharge from the hospital, arrangements are typically made with your DPC clinic for a prompt office visit or virtual visit to appropriately follow-up with your medical care.

​