Traditional health insurance is not always ideal, nor is it the right choice for everyone. Many people find that it simply doesn’t cover everything they need, or that they don’t have the access to their doctor that they need. In addition, the billing gets complicated, and your network may limit your doctors and the services you can pursue.
Another solution that has been picking up steam is direct primary care (DPC). With DPC, you simply pay a monthly fee to your health care provider’s practice. Then you obtain a doctor, usually offering both in-person and telehealth visits.
This article will go over what direct primary care is, how it works with insurance, and whether DPC is the right choice for you.
What is Direct Primary Care?
DPC is an alternative to third-party billing for physicians. Third-party billing is time-consuming, requiring doctors to see a large number of patients and often follow strict regulations in order to be compensated fairly. With DPC, providers charge their patients monthly, quarterly, or annually with the freedom to practice the care that is best for the patient.
The fees patients pay cover primary care visits, including laboratory tests, consultations, clinical, and other medical services. Patients are allowed to use health insurance for emergency expenses not covered by the DPC plan.
The idea behind DPC is to improve patient care and make sure the whole person is cared for. DPC providers can administer longer and more detailed appointments with their patients. This process gives doctors more time with their patients and doesn’t incentivize them to get clients in and out the door as quickly as possible. DPC lowers overhead expenses and makes administrative work easier, allowing practices to focus on what matters, their patient’s health.s and their health.
How Does DPC Work?
A patient pays a flat-rate fee that includes unlimited services. This fee varies based on the provider and the services they offer. The fees usually range between $65 to $15085 a month.
Some may compare it to paying for a membership to a doctor’s office. Doctors provide personalized care for their patients, and they spend much more time with them. A visit with a typical primary care physician visit usually lasts between about 5-7 15 minutes. A DPC visit typically lasts between about 20-40 minutes.
DPC works in tandem with insurance by allowing you to have unlimited services with your DPC provider, and backup health insurance can be used for the services they don’t offer. For many people, this is a great way to get more personalized services with your primary care provider, and still be covered for everything else.
Additional access to your doctor is often provided through phone and text services, appointment scheduling, and sometimes even home visits. Imaging services, medications, and lab tests are sometimes offered at a discount.
Limitations of DPC
There are many benefits offered in the DPC model for both patients and doctors. Patients like personalized care, and doctors can practice like they used to before health insurance was standard.
With more time and focus on patients, providers can focus more on the patient’s overall health, including lifestyle and wellness improvements. These services can potentially make healthcare more straightforward for everyone. As with every form of health coverage, DPC has its limitations.
Some have expressed concern that clinics cannot scale as general primary care because doctors choose the number of patients they care for – often between 350 to 1,000 versus a national average of 2,900 per physician. This setup creates an additional burden because the number of primary care doctors is limited. This has drawn criticism from some as limiting a patient’s access to healthcare.
Another limitation regards HSA accounts – patients cannot use funds from a health savings account (HSA) to pay for DPC. The Internal Revenue Service (IRS) views the fees as insurance payments, so HSAs can’t be used without paying health insurance premiums.
These issues are being addressed. The H.R. 3708-Primary Care Enhancement Act of 2019 is sought to address the issues surrounding DPC, making care more available for all. Likewise, in June 2020, the IRS suggested new regulations for DPC payments that would give patients more options and coverage. As DPC continues to mature, the network of available physicians is slated to grow, and options are expected to continue to broaden for patients.
Is DPC Worth It?
Whether or not DPC is “worth it” depends entirely on the patient and their needs. The ease of access to primary care and more concentrated and thorough approach to their health and wellness solves a lingering problem many have with the traditional healthcare system.
Supplemental health insurance policies are often recommended for the services the DPC doesn’t cover. Many patients find it works well with DPC. Some might compare it to having car insurance. You don’t need the additional insurance unless you get into an accident. The same can be compared to having health insurance in addition to DPC.
DPC is there for you for most of your basic needs and services, and you get excellent care that you otherwise may not have had available to you. Then, you have your health insurance as a backup for any additional emergency needs or services that come up.
There are also alternatives to traditional health insurance that many families and employers are starting to pair with DPC. Expect more information about these non-insurance solutions to major medical coverage in future blog posts.
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