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.
A DPC practice "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."
Mandatory disclosures include:
"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 Law111-148, 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."
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.