In this day and age, standard primary care practices involve one doctor seeing a steady stream of patients, then billing insurance for their services. Now there’s a movement transforming modern healthcare which harkens back to the days when healthcare meant a personal consultation with a physician. Here’s what you need to know about the difference between direct primary care (DPC) and concierge medicine.
Direct Primary Care vs. Concierge Medicine
Direct primary care involves a membership fee paid by either the patient or the patient’s employer. It offers personal healthcare delivery without insurance intervention. Concierge medicine also requires a membership fee for 24/7/365 access to a doctor, but also bills insurance for office or home visits.
The two seem very similar on the surface but have multiple differences. Some basic differences between them include:
- Arrangement of membership fees. While both DPC and concierge medicine require membership fees to access care, the ways in which fees are assessed can differ. In most cases, direct primary care patients pay a monthly fee and can leave the program at any time. Concierge medicine patients are committed to an annual contract and may choose to pay their fee upfront or in monthly installments.
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- Membership fee coverage. Concierge medicine fees typically cover a comprehensive screening and physical, in addition to healthcare screenings not usually supported by government programs. DPC, on the other hand, usually covers unlimited access with monthly fees.
- Insurance and third party payers. While direct primary care physicians do not accept insurance or government reimbursements, concierge medicine providers bill for appointments.. When costs veer outside the amount covered by the membership fee, concierge providers can access insurance or government programs to pay the balance.
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- In- and out-of-network referrals. Since concierge providers usually remain affiliated with an insurance network, they can refer to an in-network specialist if needed. Conversely, direct primary care physicians are without a network and insurance will likely refuse to cover specialists or testing.
- Co-pays and deductibles. While both concierge and direct primary care physicians charge a fee, concierge patients generally cannot apply this fee to an insurance deductible. However, other in-network costs like referrals and specialist co-pays may be applied to a deductible. Unfortunately, since direct primary care providers are not in-network, any co-pays or referrals will not be considered in-network.
- Availability of services. Without the need for constant insurance billing, both direct primary care and concierge care allow easily accessible appointments as well as continuity and a personal connection with a single physician. In addition, concierge physicians serve as an advocate and networking hub for patient access to other in-network specialists, testing, and more comprehensive care.
While concierge care and DPC are similarly structured, concierge care is often the better choice for those with primary insurance. Better yet, this cost-efficient model can provide you with excellent healthcare that fits into your current lifestyle.
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