For a fixed, affordable, periodic membership fee (monthly or annually for example), the patient has access to primary care services defined in the membership plan. Services outside of the membership plan incur additional costs that are usually at discounted rates. Because DPC typically does not bill insurance, the administrative burden is removed, overhead is low, and therefore costs are significantly lower. DPC physicians may refer to entities that do bill insurance including specialists (e.g. cardiology), imaging centers (e.g. for CT scans, MRIs, other procedures), physical therapy, occupational therapy, home health, etc.
DPC is an attractive alternative for patients without insurance, who are underinsured (high-deductible and co-insurance) and for the insured for high-value services. Often times, there are primary care services in the membership plan that are not accessible in a traditional primary care practice. DPC places a high value on access, continuity of care, and quality. This high-value care prevents delays in access, which may delay an important diagnosis and treatment, resulting in a negative health outcome. DPC is different from ‘concierge’ practices in that concierge practices have a higher membership fee, bill insurance on top of membership fee, and caters to high income patients. DPC practices have affordable membership fees, does not bill insurance, membership fees are the primary revenue source, and membership fees may be paid by patients or their sponsor, like a small business employer. DPC pricing is transparent and removes surprise billing from insurance companies.