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Interesting idea

So I just had an interesting experience. I received a call from a doctor in another part of my state wanting to pick my brain about DPC (3rd time this has happened since I opened up 11 months ago, so cool!). We got to talking and she told me a practice that a DPC doctor just over the state line from her is doing. It seemed shady to me but I was curious about what the collective wisdom here thought about it.

Apparently this other-state DPC doc will do a full physical on all new patients and give them a copy with invoice so they can attempt to get reimbursement from their insurance for their free ACA yearly physical. He prices his physical at the exact same price as a year's membership at his clinic so many of his patients end up getting reimbursement from their insurance for what is essentially a year's membership.

I can't immediately find anything wrong with that, but it just seems like a bad idea.

Thoughts from the group?


  • I suppose if that doc's yearly physical includes a free annual membership to his DPC that it isn't problematic (Semantics; I'm not a lawyer). Really the insurance is getting a better deal whether they know it or not. Not only is the patient getting an annual preventative care visit but also ongoing primary care for a year for no extra charge to the insurance company. I suspect the insurance companies have a "max" they will pay for this service anyway so it's probably not always completely reimbursed.
  • IF this doctor is actively promoting or suggesting patients do this, it COULD be a dangerous idea legally for a few different reasons: 1) A DPC patient-practice agreement must be very clear about what the fees cover, so the fee/invoice provided to patient is only partially reflecting that agreement, 2) Some state DPC laws actually prohibit patient from insurance reimbursement for DPC fees (KS and a few others).

    Ultimately, a patient can take any receipt you provide them and do as they wish, but I would be very cautious in promoting a patient try this.

    I do think it's very unlikely action would be pursued by an insurance company about an issue like this, but I could certainly see a state insurance commissioner using it to go after a DPC doc.

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