Direct Primary Care vs. Insurance Explained Simply

Direct Primary Care is a form of private practice medical clinic that meets three criteria:

 1. Patients pay a periodic fee.

2. Insurance is never billed.

3. Any additional charge per visit is less than the monthly fee.

DPC was born from the broken healthcare system.

The father of DPC, Dr. Garrison Bliss, decided to open the first ever DPC clinic in the late 90s after two of

his partners left the practice to establish the first concierge practice. Dr. Bliss didn’t want to charge

$1,000 per month, so he calculated that he could make a good living while caring for 600 patients with a

price range between $35 and $50 per month. Just like that, Seattle Medical Associates was formed in

1997. Dr. Bliss had 600 patients by the end of the first year, and helped to pass state legislation where

he coined the term Direct Primary Care.

Dr. Bliss will tell you that DPC is about “a patient, a doctor, and a commitment.” That means that your

doctor isn’t going to let your insurance company come in between you and the care you need.

One thing to watch out for in the DPC world is what we call “DINOs,” or DPC In Name Only. The most

common types are hybrid and concierge practices. A hybrid clinic mixes monthly fees and insurance

billing, which either costs more money or leads to shorter visits and less access to the doctor. Concierge,

on the other hand, mixes high monthly fees with insurance billing. 

The real magic with DPC is that it cuts out the middleman. DPC doctors don’t bill insurance, which

means you aren’t paying for a billing staff, or a full time employee to process insurance denials. DPC

doesn’t require an expensive medical record system optimized to nickel and dime you or your insurance.

What are the main advantages over insurance based clinics?

1. Appointment times: The typical doctor visit is now down to 15 minutes, and the doctor spends fewer

than 7 of those minutes with you. You show up early, the doctor is late, and everyone is stressed. DPC

appointments are typically 30-60 minutes, they’re available within 24 hours for when you are sick, and

the doctors’t late, because they aren’t trying to see 24+ patients a day.

2. Billing: Much of an insurance based doctor’s time is spent on billing. Every interaction requires them

to enter a code into the system so you and your insurance can be billed. Some visits generate up to 10

codes. This has a cost. It is estimated that 14.5% of the money your doctor charges is spent on billing

alone. That’s money that you worked for that’s going to paperwork and red tape instead of medical

care.

3. Insurance approval: Your insurance will review your medical records to look for opportunities to deny

referrals, procedures and medications. Because DPC doctors work for patients instead of insurance

companies, they aren’t interested in preventing you from getting the care you need. They’ll generally

work with you to find a way to get the care you need, rather than what the insurance company is willing

to pay for.

4. Appointment availability: DPC doctors have fewer patients than traditional insurance based doctors.

As a result, they are able to keep appointments available to see patients within 24 hours. The goal is to

handle things that might otherwise send patients to an urgent care or hospital in a low stress, no

additional cost clinic visit. And they might not even have to visit the clinic, many things can be done over

the phone, through text, or on video calls.

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