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What Is the Difference Between Concierge Medicine & Direct Primary Care?

The terms “concierge medicine” and “direct primary care (DPC)” and are often used interchangeably. While both are alternatives to the traditional primary health care model, there is a fundamental difference between the two that patients should be aware of when choosing their health care providers.

Concierge Medicine

This membership-based primary health care model was established to meet the demands of certain individuals who wanted to avoid the hassles of traditional fee-for-service health care. In exchange for a monthly concierge fee, patients receive extended access to select doctors, including same-day appointments and round-the-clock telemedicine consultations. To accommodate this extended access, concierge doctors generally limit their patient panels to several hundred patients at most (as compared to the typical 2,500-plus patient panel of a traditional primary care practice).

Significantly, the monthly fee paid to a concierge practice covers only those services that are not covered by insurance. Therefore, many concierge doctors also bill their patients’ health insurance providers for medical visits. As a result, most patients pay a premium for primary health insurance in addition to the monthly concierge fee.

Direct Primary Care

Like concierge medicine, DPC is a membership-based primary health care model in which patients pay a monthly fee that entitles them to extended access to select doctors. However, DPC completely eliminates insurance companies and other third parties from the equation – DPC doctors do not bill their patients’ health insurance providers for medical visits. This means the overhead associated with procedure coding, claim filing, write-offs, billing, and claims-centric electronic medical records (EMR) systems is also eliminated, further streamlining the health care process.

DPC members do not need to pay for costly primary health insurance in addition to the monthly membership fee. With that said, they are still encouraged to carry insurance to cover the costs associated with specialist care for complex illnesses and injuries, hospitalizations, and life-threatening emergencies.

In sum, DPC is a primary care practice model that is directly reimbursed by the patient for both doctor access and primary health care services. Unlike many concierge practices, however, a DPC practice does not accept or bill third-party payers – this is the main difference between the two health care models.

If you have questions, you are welcome to contact Optimum Direct Care. We’ll be happy to tell you about our DPC practice, which is led by Dr. Toni “Muzzi” Muzzonigro and located near Orlando, FL.

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