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  • Writer's picture Lauren Svensen FNP-C

What is Direct Primary Care?

In the direct primary care model, the healthcare provider bills the patient a fixed monthly rate. It works kind of like a gym membership. The patient typically gets unlimited office visits, telehealth, same-day appointments, and discounted or free labs included with the monthly membership fee. But what about the copay?? Because the provider does not bill insurance there is no copay, this means there is no additional fee for each visit, just the monthly membership fee. Billing insurance is inefficient and increases administration time, and time spent away from the patient. Many clinics hire an additional person to help with the administrative tasks of billing insurance. Not billing insurance gives the provider greater freedom to practice because they are not forced to practice in a way that makes the insurance company happy. For example, answering patient questions in the electronic health record is important and can be time-consuming, but this is not a billable activity for insurance. Insurance companies also create extra work for providers with prior authorizations. A prior authorization occurs when the insurance company does not want to pay for the drug until they receive more documentation of what other drugs and interventions the patient has already tried. This activity is important in helping the patient get the care they need but the provider is not reimbursed for their time spent doing prior authorization paperwork by the insurance company. A direct primary care provider would be reimbursed for time spent on prior authorizations. Direct primary care providers are always reimbursed for their time regardless of the activity which allows them to be flexible and provide a high-value service.

So what’s the catch?

Direct primary care providers are committed to giving patients a better value for their money and eliminating healthcare waste. Patients will incur additional costs for any care received outside of the primary care clinic, like specialists, hospitalizations, imaging, and medications. Direct primary care providers are savvy shoppers and want to help you find the best deal in town for imaging, medications & other expenses. Additional expenses can be paid for with a health savings account, high deductible plan, or health sharing plan.

But how do you make money with such great prices?

By eliminating healthcare waste, direct primary care providers can offer a fair price for their services. This is a tried-and-true growing business model. Spirit Primary Care is the closest direct primary care clinic to Chapin, SC (don’t believe me, check out this map ) we offer services to individuals and employers, if you are interested in learning more call or text Lauren at 803-8-SPIRIT.


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