Is DPC legal?

(Robin Dickinson) #1

@jpkeese @appalenia This topic came up in another thread. I know some of this varies from state to state (the OP is in California). But I know people are managing to do this in every state.

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(Appalenia Udell, Esq.) #2

I’m a health lawyer specializing in DPC; I’m licensed in CA, CO, and WA. A few things here:

  1. California made a terrible attempt at a DPC law that died a horrible death in committee and it will likely require some turn over before another law is capable of being successful. In the meantime, DPCs in California remain vulnerable and need to be very clear about the fact that they don’t assume risk. Claims about 24/7 availability for care are more likely to lead to a finding that the practice is bearing risk and therefore constitutes the practice of insurance. Also of note here is how we describe the difference between DPC and traditional delivery.
    MedLion was penalized heavily by a Florida court, in part, for making flowery claims about “superior” or “excellent” care. While we all feel strongly that DPC is superior care, we want to be mindful about what we say in our marketing.
  2. HIPAA is a floor when it comes to patient privacy, not a ceiling. Many (if not most) states have consumer or patient protection laws that are much more rigorous than HIPAA; California is a perfect example of this.
  3. The per visit fee is an interesting market mechanism that actually defines in part the differences between DPC, Concierge, and Boutique medicine models. These are terms of art but generally, DPC has no per visit fee, or if it does, it is less than the periodic membership fee. Concierge charges an “access” fee to be part of the practice and may or may not bill insurance in addition to the access fee. Boutique medicine typically does not bill insurance at all and relies on a cash pay model that may or may not have a membership fee plus a per visit fee. My general advice is to figure out what kind of practice you want to have, what your market will bear, and then let’s sort out the legal issues for your ideal practice. Health law is always evolving, and very rarely are their black and white answers. Every practice is unique and you should be wary of a one-size fits all approach to your legal compliance.

(Robin Dickinson) #3

@appalenia I love how thorough you are! Thank you!

@cjs56 I hope this answers some of your questions. Feel free to ask more here. I can also personally recommend @appalenia as I worked with her a lot during the Colorado DPC legislation. She’s a good person to have on your side!

(cjs56) #4

Thank you Appalenia Udell.

  1. What is a good resource (on-line or journal) that I can read more about the so-called terrible attempt of the CA DPC law?
  2. Did this law have to do with so-called holding out as an insurance company?
  3. What turnover do you foresee that a new law would require?
  4. what assumed increased/unneccesary risks have you seen some of the CA DPCs take?
  5. I do not see why 24/7 availability would constitute the practice of insurance? Why is this so?
  6. The FL MedLion case can be found on the web?
  7. So, regarding EMRs and patient privacy protection (H.I.P.A.A.), even though a D.P.C. practice may have a disclaimer at the bottom of each email communication between patient and physician, and even though the D.P.C. practice may claim it does not fall under H.P.P.A.A. regulations because the practice does not have the required number of employees in order for it to fall under H.I.P.A.A. regulations, it still is necessary to have a secured patient portal? This is because of consumer or patient protection laws?

(cjs56) #5

What city/state is Appelenia Udell located?

(Robin Dickinson) #6

@cjs56 She’s licensed in CA, CO, and WA and works with DPCs in all three states.

(Kevin Miller) #7

Appalenia, timely to see this. I’m in CO and just this morning having to deal again with out of state inquiries. Is this an area you can give us counsel in? You can email me at

(Appalenia Udell, Esq.) #8


  1. Happy to forward you the committee notes, just send me an email at
  2. The bill sought to exclude DPC from insurance regulation, but it was fraught with other issues that doomed it; you can read these in the committee notes.
  3. 50% or greater turn over in the committee members would be probably necessary for there to be a reasonable chance at success.
  4. Largely inflated or hyperbolic claims about superior care as well as poorly constructed agreements with employers that are incomplete and/or not geared for sustainability.
  5. The Knox-Keene Act contains standards about how HMOs must manage their memberships. 24/7 claims start to look like some of these standards and thus draw an allegory between DPC and HMO thereby suggesting that regulation would be necessary.
  6. No, I had to specially request this from my legal database.
  7. Happy to discuss this with you in depth, feel free to give a call or send an email.
  8. We are based out of Centennial, CO but travel frequently to see clients on the west coast.

(Appalenia Udell, Esq.) #9

Hi Kevin, just sent you an email.