As of May 26, 2017 became the 22nd state to pass a DPC defining "not insurance" law with SB 94. DPC practices are known to be operating within the state. The law was well written. It has a clear definition of DPC, a robust set of mandatory disclosures, and interestingly was also written to include dentists as well as primary care physicians.
Here is the entire language of the Alabama DPC law:
Section 1. This act shall be known and may be cited as the Alabama Physicians and Dentists Direct Pay Act.
Section 2. (a) For the purposes of this section, the following words shall have the following meanings:
(1) DENTIST. A person licensed to practice dentistry in this state.
(2) DENTIST AGREEMENT or AGREEMENT. A contract between a dentist and a patient or his or her legal representative in which the dentist or the dentist's medical practice agrees to provide dental services to the patient for an agreed upon fee and period of time.
(3) DENTIST PRACTICE. A dentist or a dental practice of a dentist that charges a periodic fee for dental services and which does not bill a third party any additional fee for services for patients covered under a dental agreement. The per visit charge of the practice shall be less than themonthly equivalent of the periodic fee.
(4) PHYSICIAN. A person licensed to practice medicine in this state.
(5) PHYSICIAN AGREEMENT or AGREEMENT. A contract between a physician and a patient or his or her legal representative in which the physician or the physician's medical practice agrees to provide health care services to the patient for an agreed upon fee and period of time.
(6) PHYSICIAN PRACTICE.
(a) A physician or medical practice of a physician that charges a periodic fee for medical services and which does not bill a third party any additional fee for services for patients covered under a medical agreement. The per visit charge of the practice shall be less than the monthly equivalent of the periodic fee.
(b) A physician agreement or dentist agreement is not insurance, may not be deemed an insurance arrangement, and is not subject to state insurance laws.
(c) A patient or legal representative shall not forfeit any insurance benefits or Medicare benefits by purchasing medical services or products outside the system.
(d) A physician or dentist offering, marketing, selling, or entering into a physician agreement or dentist agreement may not be required to obtain a certificate of authority or license other than to maintain a current license to practice medicine or dentistry in this state.
(e) A physician agreement or dentist agreement is not a discount medical plan.
(f) To be considered a physician agreement or dentist agreement for the purposes of this section, the agreement shall satisfy all of the following:
(1) Be in writing.
(2) Be signed by a physician or dentist, or agent of the physician or dentist, and the patient or his or her legal representative.
(3) Allow either party to terminate the agreement upon written notice of at least 30 days to the other party.
(4) Describe the scope of health care or dental services that are covered by the periodic fee.
(5) Specify the periodic fee and any additional fees outside of the periodic fee for ongoing health care or dental services.
(6) Specify the duration of the agreement and any automatic renewal periods and require that no more than 12 months of the periodic fee be paid in advance.
(7) Prominently state in writing that is conspicuously visible and in bold font all of the following:
a. The agreement does not constitute health insurance of the laws of this state.
b. An uninsured patient that enters into an agreement may still be subject to tax penalties under the Patient Protection and Affordable Care Act, Public Law 111-148, for failing to obtain insurance.
c. Patients insured by health insurance plans that are compliant with the Patient Protection and Affordable Care Act already have coverage for certain preventive care benefits at no cost to the patient.
d. Payments made by a patient for services rendered under a physician agreement or dentist agreement may not count toward the patient's health insurance deductibles and maximum out-of-pocket expenses.
e. A patient is encouraged to consult with the patient's health insurance plan before entering into the agreement and receiving care.
(8) Provide that, upon termination of the agreement by the patient, all unearned fees are to be returned to the patient.
(g) A physician or dentist providing health care or dental services under a physician agreement or dentist agreement may decline to accept a patient if, in the physician's or dentist's opinion, the patient's medical condition is such that the provider is unable to provide the appropriate level and type of health care or dental services the patient requires. The physician or dentist may discontinue care for patients under the physician agreement or dental agreement under any of the following conditions:
(1) The patient fails to pay the periodic fee.
(2) The patient has performed an act of fraud.
(3) The patient repeatedly fails to adhere to the recommended treatment plan.
(4) The patient is abusive or presents an emotional or physical danger to the staff or other patients of the physician practice or dentist practice.
(5) The physician or dentist or the physician's or dentist's medical practice discontinues operation as a physician practice or dentist practice.
(6) Any other condition consistent with the Alabama Medical Practice Act or the rules of the Alabama Board of Medical Examiners and the Alabama Medical Licensure Commission, or the Alabama Dental Practice Act and the rules of the Alabama Board of Dental Examiners.
Section 3. This act shall become effective on the first day of the third month following its passage and approval by the Governor, or its otherwise becoming law.
Dispensing - The Alabama Board of Medical Examiners does require that dispensing physicians register. The one page form is not much of a burden and there appears to be no cost associated with the registration. Only those dispensing "controlled substances" need to register, so the board's definition of a controlled substance might be worth clarifying prior to registration.
Physician Dispensing Defined
Physician Dispensing Overview Page
Dispensing Physician's Registration Form
Insurance Code - When designing your contract be sure to review the Alabama Insurance Code, most importantly Title 27, Code Of Alabama 1975, including Section 27-21B (Health Insurance) and Section 27-21A (Health Maintenance Organizations). Some of the most important definitions are included below.
(2) INSURER. A health insurer, including a group health plan as defined in Section 607(1) of the Employee Retirement Income Security Act of 1974, a health maintenance organization, or an entity offering a service benefit plan.
(7) HEALTH MAINTENANCE ORGANIZATION. Any person that undertakes to provide or arrange for basic health care services through an organized system which combines the delivery and financing of health care to enrollees. The organization shall provide physician services directly through physician employees or under contractual arrangements with either individual physicians or a group or groups of physicians. The organization shall provide basic health care services directly or under contractual arrangements. When reasonable and appropriate, the organization may provide physician services and basic health care services through other arrangements. The organization may provide, or arrange for, health care services on a prepayment or other financial basis.
(2) BASIC HEALTH CARE SERVICES. Emergency care, inpatient hospital and physician care, and outpatient medical services.