My team and I have been continuing our research on state regulations and how practices can efficiently set up membership programs for their dental practices. During our research we have found a beneficial strategy called “DPC law” (Direct Primary Care) where a practice can simply create a “medical retainer agreement” – See template below (May vary in different states) which will allow your practice to bypass any insurance regulations in most states. This gives me and my team hope as our goal is to help as many dental practices as we can create, organize, grow and automate an in-house membership program.
I have seen a few states with heavy/harsh insurance regulations but the DPC law and medical retainer agreement may be able to allow your practice to create a membership program and you won’t have to abide by insurance regulations. Of course you still shouldn’t call your program insurance. According to Jeremiah Riley an Attorney from Salt lake City Utah, dental practices should do the following:
“Make sure your dental membership plan is a Medical Retainer Agreement, not a Health Discount Program. According to Utah law, a valid Medical Retainer Agreement (which is the legal document you will create to implement your dental membership plan) must include:
1. a description of “specific routine health care services that are included in the contract;”
2. a written statement that the retainer agreement is not health insurance; and
3. text that clearly prohibits the health care provider from billing an insurer for the services delivered under the agreement (i.e. the membership program).
In summary, dental membership programs can be great for dental practices. However, they can easily resemble insurance plans, if the dental practice implements them incorrectly. And if you dental membership program looks like an insurance plan, the Insurance Commission will probably treat it like one. “
These laws are specifically for Utah practices but may be similar in other states. Another example of this law can be found in Michigan:
“State Sen. Pat Colbeck, R-Canton, believes the path to providing Michigan citizens with access to higher quality, lower cost health care has been cleared following Gov. Rick Snyder’s signature into law of Colbeck’s SB 1033 (Public Act 522 of 2014).
“According to Colbeck, this legislation ensures that direct primary care services are not treated as insurance products by regulators’
The new law assures physicians who adopt a direct primary care service business model(AKA membership model, subscription model) that the administrative burden associated with insurance regulations will not interfere with their treatment of patients. Physicians who offer direct primary care services provide specified services for a monthly subscription fee that usually vary between $50 and $125 per month.”
What is Direct Primary Care?
According to dpcare.org, Direct Primary Care (DPC) is an innovative alternative payment model improving access to high functioning healthcare with a simple, flat, affordable membership fee. No fee-for-service payments. No third party billing. The defining element of DPC is an enduring and trusting relationship between a patient and his or her primary care provider. Patients have extraordinary access to a physician of their choice, often for as little as $25 – $70 per month, and physicians are accountable first and foremost for their patients. DPC is embraced by health policymakers on the left and right and creates happy patients and happy doctors all over the country!
Is Direct Primary Care legal?
*this segment was taken from – https://www.aafp.org/fpm/2016/0900/p12.html
Yes, DPC is “not insurance” (since there is no risk transfer), and legal DPC contracts can be drafted in every state. As of Aug. 16, 2016, 17 states have passed laws related to direct primary care. (See “Direct primary care laws by state.”) Most of the state legislation is motivated by a desire to define DPC as “not insurance” so that the state insurance commissioner does not feel obligated to prohibit or regulate the practice model. DPC is arguably legal in every state without this legislation, but legislation is often helpful because it clears up legal gray areas and thus removes barriers to physician adoption of the model.
Why We need DPC Law
Defining DPC in no way restricts your freedom to contract with a patient in any way you like. You could intentionally change the contract to NOT be defined as DPC if this suits your interests more. Definitions are needed when there is a gray area in the law – you either get there via legislation – legislation that DPC Frontier can help author and shape – or via a judicial decision – an area of uncertainty that most physicians fear.
A definition of DPC in each state = lower legal barriers to entry = less uncertainty = wider adoption of DPC.
You can read more here – http://www.dpcfrontier.com/definition-explained
State DPC Laws
This is a snapshot of the states that currently support DPC laws. The links below will take to specific states and help you understand what you need to do to be compliant and to not be seen as an insurance provider.
This resource for the DPC law is a website created by Dr. Eskew which allows you to see a map of each state and link to resources about the DPC laws in each state –
I believe this law is a game changer for most practices wanting to create an in-house membership program – Hopefully with BoomCloud’s help 😉
My team and I will continue doing our research to help the dental industry win the battle with dental insurance. We are currently talking to attorneys in states across the nation to help us understand what practices need to do to set up a successful and compliant membership program. We will be creating a podcast series on The Navigating Dental Insurance Podcast (SaynoToPPOs.com) specifically talking with attorneys about this law and how dental practices can leverage this law to create recurring revenue and give patients a better quality care. We also will be posting more information and resources to help your practice on our website!
If you are interested in starting an in-house membership program. Schedule a demo with our team today and we will guide you on what you need to do to make this work for your practice.
**This article is not intended to serve as legal advice. We recommend you speak with your attorney or legal counsel to see how DPC and a Medical Retainer Agreement can benefit your medical or dental practice.