Billing Question


(Brian Colbert) #1

We keep getting asked a version of the following question:

Is there is a way that a DPC can submit claims for the monthly fee members pay?


(cjs56) #2

I am not sure but possibly the monthly fee could be applied for NON-covered services.


(Robin Dickinson) #3

@brian Some people have billed the entire year as an “annual” and tried to get reimbursed that way. The problem is that my understanding is that it’s illegal. You should probably check with a lawyer before you try to do something like that. @appalenia worked with me on the DPC bill here in Colorado so I’m tagging her to see if she agrees.


(Appalenia Udell, Esq.) #4

Hi @brian,
Can you provide a bit more context for the question and who the querent is?

If this is coming from patients, likely what they are looking for is a super bill or a green light on HSA fund use for DPC fees. If this is the case, you may want to consider addressing that specific market need and possibly modifying your business model.

If this is coming from an employer, likely they are looking to roll DPC fees into their existing health plan costs. Though some large insurers have DPC plans, we are not aware of any California plans offering a DPC component. However, if the employer has an ERISA plan, then they may be able to incorporate DPC fees into their plan.

If this is coming from the media, DPC hasn’t been properly explained to them and they need more education.

In any case, a good way to talk about it with direct consumers is something along the lines of: DPC is a cost-based approach to healthcare that restores the patient-physician relationship by removing expensive obstacles to care. For example, the cheapest plan for a family of 4 on the CA Exchange costs $14k in premiums with an additional $12.6k in deductibles. Conversely, that same family of 4 can get unlimited primary care through a DPC for about $xx.xx per year. Obviously, maintaining health insurance for services other than primary care is always advisable, but DPC is a great way to get primary care needs met in an era of soaring insurance costs. By framing DPC fees in the context of overall healthcare costs (assuming the math makes financial sense), then the desire to shift the cost of DPC fees is obviated.

I know that this is a dense answer and I’m not sure I’ve answered your underlying question. If you’d like to discuss this further, always feel free to call us on 510.682.0766.


(Robin Dickinson) #5

@appalenia Thanks so much for your input! You are thorough as always.


(Brian Colbert) #6

Thanks for the response. Apologies for the delay in getting back to you. I left you a vm earlier this morning.


(Brian Colbert) #7

The querent is wondering if there is any why to be able to claim her monthly membership fee against her insurance premiums and/or deductible. She has has large medical bills is is seeking away to better utilize her insurance.


(Appalenia Udell, Esq.) #8

Hi @brian,
Regrettably, there probably is not a way for her to off-set the cost of her membership fee, particularly in a concierge setting. By definition, concierge fees are non-covered services that are ineligible for reimbursement as a “healthcare cost.” It sounds like perhaps her insurance is the problem and not necessarily the membership fee itself? It is possible that a healthcare sharing ministry might be able to help her reorganize her healthcare spending. Also, for true DPCs, some HCSMs kick in a portion of the monthly DPC fee.


(Brian Colbert) #9

Thank you.