Question: Why Don’t the Insurance Companies Send All Their Patients to DPC Doctors?

You would think that since DPC doctors do not send ONE bill to the insurance companies that Anthem, UnitedHealthcare, etc. would want all their patients to go to DPC doctors, right? They would also need less staff who spend time processing, and rejecting, bills from primary care doctors. It doesn’t make sense…..or does it? Could it be that these insurance companies:

  • Want full control of the patients, as far as referrals, labs and diagnostic tests?
  • Want all the data from the EMR and quality metrics so that they can sell it? DPC doctors refuse to give them patient information or do metrics, which is the way it should be.

What are your thoughts?

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Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  8 comments for “Question: Why Don’t the Insurance Companies Send All Their Patients to DPC Doctors?

  1. Holly
    August 12, 2019 at 8:30 am

    Many employer insurance plans are self-funded, with claims administered by insurance companies. Every transaction has a cost – to the employer. Consequently, decreasing claims processing decreases income for insurance companies, which decreases jobs in the insurance industry.

    Not defending insurance companies but eliminating US health insurance will cost thousands of jobs. We tend to focus on the top 1 % who receive obscene compensation and forget about the average Joe and Jane who are just trying to support themselves and their families. Where will they go? How long will it take for the US economy to develop and integrate all of those individuals into new careers? How many of them have a transferable degree that makes a employment move easier?

    Coming up with a solution that minimizes the financial impact on all that are involved is not easy. Case in point, how many of you who switched to DPC model thought about the support staff the probably lost their jobs at the institution who previously employed you?

    As a retired office manager, married to a still practicing physician, the one thing that I find most frustrating about our failing healthcare system is how we tend to view the problem from our very narrow lens and ignore the ancillary parts. Until we are honest about how change will be disruptive and acknowledge, honestly again, who will be the most disrupted, we aren’t going to solve this quagmire of a problem.

  2. August 10, 2019 at 3:27 pm

    MLR of 80/20. More claims they process the bigger percentage of a bigger pie they get 🙂 perverse economics

  3. Jaclyn Nadler
    August 9, 2019 at 9:33 pm

    Insurance companies profit on patients thinking they are getting a deal with the “discounts” or negotiated rates through their insurance. It misleads people to believe they need insurance or run the risk of going bankrupt. DPC opens patients eyes to the real costs of healthcare and this terrifies insurance companies. DPC also breaks the chain of control insurance companies and large hospital corporations have over control of physicians which they count on.

  4. August 9, 2019 at 3:12 pm

    They (ins. companies) can’t handle the truth. They don’t understand the truth and they certainly don’t value the truth. All they care about is money and metrics and profits and control. If they were to acknowledge the value of what we do in DPC, their foundation would have to shift substantially. So even know it would be profitable to them to pursue partnering with the DPC movement, they won’t because they would have to change their ways… which they won’t do – unless their forced to do so. IMO, the only way that could happen is if the American people force them to change. time will tell. In the meantime, DPC should keep it’s distance from the insurance industry and peacefully co-exist.

  5. Jennifer Hollywood
    August 9, 2019 at 3:09 pm

    In my state the insurance company is required to spend a certain percentage of their gross income on patient care. If patients go to DPC and the insurer doesn’t pay for anything then the amount of money the insurer can keep is smaller (or theoretically zero). They need to spend money to keep money. Therefore more spending means more money for the insurer in a weird backward way. And they can collect more premiums the following year!!

    • August 9, 2019 at 3:17 pm

      Yes, the fundamental flaw of both the premise of and the regulation of insurance – their profit is (last I checked) fixed at 20% of total cost of insured care.

      20% of $1 billion is >> 20% of $100 million

      Which would you rather get as an annual bonus – $200 million or $20 million?

      Pay no attention that the biggest cost is erosion of the integrity of the entire system of organized medical care.

    • Bridget Reidy
      August 9, 2019 at 9:29 pm

      This is crazy! The point of insurance is for them to make money when you don’t need it and lose when you do (above the premium plus deductible). If what is say here is true, they make zero on all the years your care costs less than deductible, which for healthy people is most years. How then can they fund the expensive years/people?

      • Jennifer Hollywood
        August 10, 2019 at 7:24 am

        It’s averaged over everyone and not an individual so someone is always using the money. Plus they find bullsh*t ways of saying they are spending money on patients. Educational flyers. Phone calls from nurses or pharmacists to see if you are being healthy. I am sure these services are overcharged to a different pocket of the same parent company. So they say they are spending money on patients this way. It doesn’t have to just be direct patient care.

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