Ohio does not have any clearly labeled DPC "not insurance" law or legislation at this time, but an older "Discount Medical Plan" law is worth reviewing. Readers should review ORC Chapter 3961: Discount Medical Plans. It appears that this law was passed to help certain administrative middlemen negotiated discounts with various groups of medical practitioners. These middlemen (known as "discount medical plan organizations") could market their "plans" as outside of insurance by disclosing that the plan was "not insurance" on their marketing materials. Does this law provide any legal cover for DPC practices? The answer is unclear.
In our case we would argue that the DPC practice is the "discount medical plan organization (DMPO)" which means a person who
- does business in this state;
- offers to members access to providers of medical services and the right to receive discounted medical services from those providers;
- contracts with providers, provider networks, or other discount medical plan organizations to offer discounted medical services to members; and
- determines the fee members pay to participate in the plan.
The DPC patient contract would need to include: "a copy of the terms and conditions of the discount medical plan, including any limitations or restrictions on the refund of any processing fees or periodic charges associated with the discount medical plan." The contract with the patient should be free of the following dirty words: "health plan," "coverage," "benefits," "copay," "copayments," "deductible," "pre-existing conditions," "guaranteed issue," "premium," "PPO," "preferred provider organization,"or any other terms in a manner that could mislead a person into believing that the discount medical plan is health insurance.
There are many odd requirements that really do not apply to DPC practices within this law. The DMPO must maintain a toll-free telephone number along with procedures for receiving complaints and sending these to the state department of insurance. Any "enrollment fee" is essentially limited to $30 (Section 3961.06(B)), so to cover up front costs you would need to have another type of fee such as an "initial visit fee" that would be clearly nonrefundable. The most problematic statement in the law is as follows (section 3961.05(E)): A DMPO shall not "[p]ay providers fees for medical services or collect or accept money from a member to pay a provider for medical services received under the discount medical plan." This weirdly appears to prohibit a DPC practice from accepting a payment from the patient and then turning around to use this payment to pay salaried physicians that are working in the practice. For a DPC practice to reliably use ORC Chapter 3961 to be in the "not insurance" category the practice would oddly need to use a third party DMPO rather than being the DMPO themselves.
It would appear that the definitions of plans, insurance, and contracts that are contemplated in various portions of the Ohio Revised Code do not present problems for most DPC practices, but the advice of a local Ohio attorney is recommended. Be sure to review the Ohio Insurance Code when planning your DPC practice. The Ohio Academy of Family Physicians has been supportive of the DPC model.
In office dispensing is permitted in Ohio. The State of Ohio Board of Pharmacy requires that dispensing physicians obtain a Terminal Distributor of Dangerous Drugs license. All the details and applications can be found on this Ohio Board of Pharmacy webpage.