If you are looking for a new primary care physician, you may be wondering what the difference is between fee-for-service providers and direct primary care (DPC) providers. Essentially, fee-for-service providers charge you for every service they provide and usually bill your insurance company directly. Alternatively, DPC providers charge a monthly subscription fee to cover their operational costs and either do not charge for basic services or charge a low fee. If you are considering signing up for a DPC program, there are several things you should know.
There Are Several Types of Direct Primary Care
Just as fee-for-service medical practices follow different standards and methods, each DPC practice has its own set of standards. For example, some boutique DPC practices charge high monthly fees and no fees for regular visits. Other DPC practices concentrate on offering low monthly fees but may charge a small fee for each of your visits. Additionally, you may find many DPCs that offer extended hours or same-day appointments while others follow more traditional working hours.
It is important to remember that DPC is a method for paying for your basic medical care, not a definition of the standards of your provider. After deciding whether you prefer DPC or fee-for-service care, you still need to evaluate the accessibility and benefits of each individual practice.
Direct Primary Care Physicians Generally Have Fewer Patients
One of the main benefits for both physicians and patients when using DPC is that the physicians have fewer overall patients in their practice. For example, a fee-for-service physician may have between 2,000-3,000 patients while a DPC physician is able to limit their practice to 600-800 patients. This means that your physician should have more time to spend with you during each visit. You should also be able to schedule appointments with greater ease because fewer patients will be competing for appointments.
Ultimately, the one-on-one time spent with your doctor under a DPC program can allow your doctor to become more familiar with your health and offer you better treatment options.
Direct Primary Care Programs Are Regulated By the Affordable Care Act
You may think that DPC programs were a good option for people who did not have insurance before the Affordable Care Act came into effect, but since you are now required by law to have insurance, it is no longer a smart financial choice. However, the ACA regulates the use of DPC programs, requiring the program to be combined with insurance that covers catastrophic health care and more expensive surgeries. With a DPC program, you can usually get an insurance with a lower monthly rate and a higher deductible.
Some Direct Primary Care Practices Continue to Work With Insurance Contracts
Your DPC program may continue to work with a limited number of insurance companies. If you are covered by one of the insurance companies that the DPC works with, they will still be able to bill your insurance company for more expensive procedures. However, most normal visits, such as physical exams, will be covered by your monthly subscription fee as opposed to your insurance, meaning it will not count towards your deductible. For this reason, you should expect to pay the full cost of your deductible when you have extensive health work done.
You May Be Able to Use Your Work Insurance or Other Health Insurance at a Direct Primary Care Practice
Even if your physician no longer works with any insurance companies, you may still be able to use your insurance to pay any of the fees you pay for your medical visits that would usually be covered by your insurance. However, you will have to file claims on your own. You will need to pay your physician for their services and request an itemized bill. Then, submit your bill to your insurance company and wait for them to reimburse you. Keep in mind that most insurance companies will not reimburse your monthly subscription fee.
For more information, talk with a direct primary care practice near you.