Doctor's Guide to Concierge Medicine

(cjs56) #1

Has anyone read this book?

(Robin Dickinson) #2

I haven’t but Amazon says it’s frequently bought together with @forestdpc 's book on starting your own DPC so I’m guessing some people have!

(cjs56) #3

I will tell you a bit after I finish it.

ACA says DPC is not insurance.

But, state health commissioners say that DPC is health insurance.

How do you figure that?

Is DPC both health insurance and not health insurance?

Cigna has a product line that is DPC.

And, another health ins. company as well.

Did you know that?

(Robin Dickinson) #4

It varies from state to state. I think we’re over 50% of states now with legislation that makes DPC legally not insurance. The book might be a bit dated…DPC is changing so fast right now!

(Appalenia Udell, Esq.) #5

@Robin_Dickinson and @cjs56,
The ACA does NOT say that DPC is not insurance. What the law does say is that the Secretary of HHS shall permit a qualified health plan to be expressed through a qualified direct primary care medical home plan, based upon criteria that the Secretary establishes (42 USC 18021). The law of the ACA is expressed through regulation (45 CFR 156.245), which allows a qualified health plan issuer (insurance company) to provider coverage through a direct primary care medical home. “Direct Primary Care Medical Home” is not defined within the law, the regulation, or other guidance, in so far as I am aware. “Direct Primary Care” is a term of art that has no clear definition within the industry/movement and the legal definition varies state by state.

Indeed, CIGNA has had a DPC product since 2013; you can read the Forbes article here. Similarly, Humana has adopted Iora Health for its hybrid-DPC model.

(cjs56) #6

Thank you Appalenia.
I read in the book entitled Doctor’s Guide to Concierge Medicine that considered insurance under the A.C.A.
I will have to re-read as I most likely misread it.
I understand you clarifications.

(cjs56) #7

If more insurance companies create D.P.C. plans, will that affect private D.P.C. practices in terms if making it more difficult (competitive) for private D.P.C. practices?

(cjs56) #8

This was the wording on page 354 of The Doctor’s Guide to Concierge Medicine. I believe it is a typographical error:

Experts, writers, doctors and attorneys recommend that Concierge Medicine and D.P.C. physicians set up a separate business corporation alongside their professional corporation if they choose to bill insurers. These types of physicians should distinguish between the covered services for which they are collecting a fee, and the uncovered services for which they are billing insurance. Physicians are encouraged to develop a menu of fees and services to offer.

I understood the the retainer fee (or monthly, quarterly or annual membership fee) was to provide for services that are NOT COVERED. And, that collecting any fees would be only for COVERED SERVICES that the insurance would pay for upon receiving a bill.

(cjs56) #9

A company called Associated Mutual also offers a DPC product…according to the book.

I wonder where they are located and how their DPC market share is doing?