Washington State Office of the Insurance Commissioner

Direct health care or retainer medical practices

Direct health care practices (also called retainer medical practices) are on the rise across the country. In a direct practice, a health care provider charges a patient a set fee for all primary care services provided in their office, regardless of the number of visits. Patients pay a monthly fee. No insurance plan is involved, although patients may have insurance coverage for more costly medical services.

 

How do they work?

Direct health care practices vary, but common elements include:

  • A set monthly fee
  • Enhanced access to providers
  • No billing of insurance or Medicare

Are they legal?

Yes. Direct health care practices are not insurance, but they do accept a limited amount of risk becuse they accept money in exchange for delivering services in the future. If you pay the fee in advance, the practice must hold your money in a trust account.

In an effort to protect participants, a law was passed in 2007 that established certain requirements for any direct health care practice operating in Washington state. They also must file annual statements with our office.

 

Important facts to consider

  • Direct practices only provide primary health care services
  • They do not include coverage for hospitalization or prescription drug coverage
  • If you join a direct health care practice, consider buying a high-deductible health plan to protect yourself in the case of a medical emergency

Know your rights. Direct health care practices cannot:

  • Discriminate
  • Charge more based on health status or sex
  • Change the fee more than once a year
  • Use misleading advertising

If you feel that you've been mistreated by a direct health care practice, call our Insurance Consumer Hotline at 1-800-562-6900.



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