DPC News

OIC Report in WASH. Comes Out In December … Recap of Past OIC (Wash) Reports

Source: Wash. State OIC

Even the Office of Insurance Commissioner in the State of Washington weighed in defining Direct Primary Care by stating … A direct health care practice is a medical practice (also called a retainer, concierge or boutique medicine) that charges you a monthly fee and, in return, provides unlimited access to doctors for primary care services.  

In 2007, the Washington State Legislature enacted Engrossed Second Substitute Senate Bill 5958, which is codified as RCW 48.150. This bill created an innovative primary health care delivery option called “direct practices.” It requires all of the registered practices to respond annually to the mandatory questions. In 2015, fewer than half of the direct practices chose to report voluntary information. Some said they do not collect this information, and others simply did not respond to the supplementary questions.  The bill requires the Office of the Insurance Commissioner (OIC) to report annually to the Legislature on direct health care practices. Under RCW 48.150.100(3), this includes but is not limited to “participation trends, complaints received, voluntary data reported by the direct practices and any necessary modifications to this chapter.”

Direct health care practices

A direct health care practice is a medical practice (also called a retainer, concierge or boutique medicine) that charges you a monthly fee and, in return, provides unlimited access to doctors for primary-care services.

How they work

In our state, direct health care practices must register with us. Each is different, but all:

  • Serve as your primary care provider for all routine and preventive-care services.
  • Include a set monthly fee.
  • Don’t involve insurance, so there are no extra charges, deductibles, copays, or insurance billing.

What to consider before you sign up

  • Direct health care practices are not considered qualifying coverage under the Affordable Care Act.
  • Direct health care providers offer only primary health care services.
  • They don’t include coverage for hospital stays, prescription drugs or dental care.
  • If you join a direct health care practice, consider also buying a high-deductible health plan, in case you need more costly medical care.

Know your rights

Direct health care practices can’t:

  • Charge you more based on your health status or gender; or
  • Change the monthly fee more than once a year.

Direct health practices may charge you an additional fee that’s not part of your agreement if they notify you before you receive the service.

See also

SOURCE: https://www.insurance.wa.gov/your-insurance/health-insurance/cant-afford/health-plans/direct-health-care-practices/

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