Short answer: Before you sign, read what the monthly fee covers, what costs extra, how to cancel, and what happens if the doctor leaves. Ask for the prices in writing. Check that the practice says clearly that membership is not insurance. If a practice will not put its terms in writing, think twice.
Direct primary care (DPC) is a membership model. You pay a monthly fee to a doctor's office instead of the office billing insurance for each visit. The American Academy of Family Physicians says the fee covers all or most primary care services. Not every practice includes the same things, so look for a written list of the visits, contact methods and services in your fee. Ask whether the fee is paid monthly, every few months or once a year.
familydoctor.org, the AAFP's patient website, says prescriptions, some lab tests and some procedures may cost extra, though these are often highly discounted at a DPC office. It also says some practices charge a one-time enrollment fee. The American College of Physicians (ACP) says doctors in practices like these should be transparent with patients by explaining their financial obligations and the services available, and by disclosing typical fees for services. Ask for that price list before you sign.
The sources we read do not set out standard cancellation or refund rules, so each agreement will differ. Look for how much notice you must give, whether you can leave in the middle of a billing period, and whether any money comes back if you do. Make sure you understand any minimum length of membership. If something is unclear, ask the practice to explain it in plain words.
A small practice can change quickly if the doctor moves, retires or closes. The ACP has said that practices that shrink their patient lists should help departing patients find other doctors. Ask the practice what it would do for you, how you would get your records, and whether you would get back any fee you paid ahead of time.
No. The American Academy of Family Physicians says a DPC membership is not insurance. The Tennessee Department of Commerce and Insurance says a DPC agreement operates independently of a person's health insurance plan. It also says the state does not review the doctor's office finances or whether the fees are fair. That statement is from Tennessee, and rules in other states can differ, so check your own state's insurance department. Because it is not insurance, you still need coverage for emergencies and hospital care. In an emergency, call 911.
Be careful with any practice that will not answer these questions in writing. You can find a direct-pay doctor near you and compare agreements from two or three offices. If you want the basics first, read what direct primary care is, or see what direct primary care costs in each state so you can compare a practice's price list.
No. The AAFP says a DPC membership is not insurance, and Tennessee's insurance department says such an agreement operates independently of a person's health insurance plan.
Tennessee's insurance department says it does not review a doctor's office finances or whether DPC fees are fair. Other states may differ, so ask your state's insurance department.
The ACP says physicians should be transparent about financial obligations, available services and typical fees. Ask for these in writing.
