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Out of Network Referrals

Opening my DPC practice next month. So excited! Those of you that are 'pure' DPC, how are you handling referrals for specialists and studies for the insured patients? A surprising number of my Medicaid and Medicare patients have enrolled as well as patients whose insurer requires all referrals through a PCP


  • good question, happy to help. Basically we do whatever we can when we can. Depending on the scenario many of our patients will elect to go through our wholesale discounted rates because they can avoid all the hassle and paperwork and delay.

    For some patients with a strict insurance company that requires in network providers to process the referral, we will contact them and see if they are willing to sign off on the referral without seeing patients based on positive findings like labs or MRI etc... For example a patient with a URI positive for rotator cuff tear, the network PCP will sometimes agree to the console because the referral is clear-cut.

    Sometimes were not so lucky. But almost always with the patient have to go back to the insurance base world they are reminded about why they like direct primary care so much.

    Don't forget about services like Rubicon in the or Arista M.D. for specialty consults, doctor to doctor. This can be a convenient and affordable option for many.
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