Direct Primary Care

Direct Primary Care vs Insurance: How Are They Different?

May 09, 2021

Harsha Moole, M.D., MBBS

Direct Primary Care is revolutionizing the Americans approach towards healthcare. It is an innovative alternative to the insurance-based model, simplifying the process by eliminating insurance providers from the equation.

A patient's average deductible in health insurance has increased 49% since 2011, and 51% of patients with high deductible health plans must pay more than $ 1,000 before their insurance takes effect.

Instead of confusing yourself over co-pays, deductibles, and out-of-pocket costs, you can instead pay a fixed membership fee directly to your provider of choice for a range of health services.

How Does Direct Primary Care Different From Insurance?

Here are a few aspects which showcase the difference between Direct Primary Care and the insurance-based health care model.

  • Consultation Time:

    Profit is the primary motivation of insurance providers. And to maximize profits, they overwork doctors so much that they can only spend 5 to 10 minutes with each patient.

    But here, DPC providers determine their panel size, not insurance providers. Extended consultation of 30 minutes to a full hour for patients is like giving time to the patient to explain their condition without feeling rushed.

  • Doctor availability:

    The biggest difference between Direct Primary Care vs insurance model is the availability of the provider. DPC panels only 200–800 patients, compared to the traditional model of 2000 to 3000.

    No one can schedule an illness, so you deserve immediate attention from your provider. This is what DPC addresses. In DPC, patients can get same day or the next day appointments, whereas it takes around 29 days of average wait time with insurance.

  • Transparency:

    Many people forget that your provider has the right to determine any of your incurred expenses as medically unnecessary. We all heard of horror stories concerning their insurance provider, some of which ending up in bankruptcy.

    A DPC membership contract is very transparent, as you are aware of what your DPC membership fee covers. So as far as covered services are concerned, you never have to worry about a surprise bill.

    With insurance providers, you are never sure. They keep certain parts of their contracts vague and open interpretation that gives them the power to deny your claim.

  • Healthcare quality:

    Can you truly get exceptional healthcare if you share the limited time of one doctor with 30 other patients?

    From our experience, it is almost impossible. Just imagine the physical toll on doctors to those many patients under the insurance-based model. Stressed and burnt out, they cannot provide each patient with the care and the attention they need.

    As health insurance expanded, its costs skyrocketed, and many doctors saw a decline in their ability to provide quality health care and eventually returned to DPCs.

    Therefore, the Direct Primary Care model prioritizes quality over quantity. Doctors only see 5 to 10 patients a day so that they can listen to the specifics of your health concerns.

    Direct Primary Care vs Insurance
  • Potential healthcare savings:

    Apart from the top-notch quality healthcare that patients like you will get, you will also access potential savings from:

    • Heavily discounted out-patient services:

      A $50-$60 CBC test will cost you only $1-$2 in a DPC clinic.

    • Cheaper prescription costs:

      Some DPC clinics have their dispensary, so they get various medications at a wholesale cost. For example, a 10 mg dosage of Cetirizine can set you back $14.43. DPC clinics can offer the same medicine for $1.08.

    • Avoiding Unnecessary ER and urgent care costs:

      Because your DPC doctor makes home visits in taking a more proactive role in promoting the health of their patients, you do not need to spend on ER and urgent care costs unless necessary.

    • Reduced insurance premium:

      Although you will still need your insurance for hospital visits and subspecialty visits, you can remove your primary care services coverage to lower your premium.

      And if you want to eliminate insurance providers from your healthcare, look into healthcare sharing plans - a great complement to DPC and an alternative to insurance with lower monthly costs and deductibles.

      When comparing Direct Primary Care and insurance, the insurance model falls short in this aspect because your insurance will not automatically pay a covered benefit. You will still have to meet your annual deductible before they start sharing the costs.

  • Level of access:

    With the insurance-based model, you only have access to a primary care provider during your appointment. This means that any concerns that you did not raise during your appointment cannot be addressed, at least unless you schedule another appointment.

    Direct primary care gives you access to your doctor 24/7 and 365 days per year. In addition, you are free to text or call your doctor's personal number for any medical concern without waiting days for an answer.

  • Satisfaction Rate: The Most Important Distinction

    Considering patients' overall experience under each model, it is not surprising that DPC patients are more satisfied with their healthcare. For example, 90% of them are satisfied with DPC than 67% for the insurance-based model. This alone stands as proof of the value you can get with Direct Primary Care.

But this is not where the difference between the Direct Primary Care vs insurance models ends. As you will find out, their differences are astronomical.

DPC providers prioritize the welfare of their patients as the main goal of their profession and fully dedicated to providing the best care possible. This is why a growing number of Americans are switching to DPC.

The numbers never lie. If you want to see for yourself why 9 out of 10 DPC patients are happy with their healthcare, search for a DPC provider in your area and experience everything that Direct Primary Care has to offer.

Authored by Harsha Moole, M.D., MBBS

Advocate of healthcare models that promote direct relationship between patients and doctors. Founder @ FindMyDirectDoctor, LLC.

Read more here. 39.0481,-77.4728