Getting the Most from Your DPC

October 14th, 2019

If you and your family are part of a Direct Primary Care partnership with your doctor, Liberty HealthShare members are here to help you share in the costs associated with your membership.

In short, direct primary care is a contract between patients and their providers where patients are charged a set fee, usually monthly, in exchange for access to a broad range of primary care services. Fees and services vary by provider.

In most cases, Liberty HealthShare members will share a portion of the periodic fee. Members seeking reimbursement must complete a direct primary care reimbursement request form, which includes information about both their direct primary care and Liberty HealthShare memberships. The DPC reimbursement form is available in each member’s Sharebox. When first requesting reimbursement, members also must include a copy of their direct primary care agreement.

The reimbursement request also includes a section to indicate which services your DPC provider offers, which is key to determining what portion is eligible for sharing. A maximum of 75 percent, up to $75, may be eligible depending on your Liberty HealthShare and direct primary care memberships. Please note that amount is the maximum, and your plan may be eligible for a smaller share.

To expedite reimbursements and ensure accurate and timely processing, Liberty HealthShare’s medical bill processing department asks that members submit both the DPC reimbursement form and their receipt at the same time. You must submit both the reimbursement form and receipt for every DPC payment you would like to be shared. 

Some other helpful tips to remember when working with Liberty HealthShare and your DPC:

  • Members must submit both pages of DPC reimbursement request form with a receipt
  • DPC reimbursement is based on the member status with the DPC provider, but cannot exceed LHS membership level (single, couple, family)
  • If members in a LHS family or couple program use different DPC providers, they will only get reimbursed at individual rates
  • DPC fees are never subject to annual unshared amount
  • Any other services done in the DPC provider office will be processed per guidelines
  • From the Liberty HealthShare 2019 Guidelines: 
    Support for Direct Primary Care (DPC) Membership. 
    Liberty HealthShare administers an evolving program (subject to change) to encourage members to enroll in effective Direct Primary Care practices. Members may request to have a variable portion of their monthly DPC membership fees shared, the amounts of which may be adjusted from time to time by the Liberty HealthShare administration. If a practice bills separately for an office visit, those bills are eligible for sharing if the member has not also requested a reimbursement for DPC monthly fees. If a practice is identified as billing excessively, ordering unnecessary tests, or profiting egregiously from ancillary services that should be included within their DPC membership, then fees for that practice may not be shared in or the sharing stopped once identified. The sharing in DPC fees is not an entitlement of membership, but a gift of other members. DPC sharing may not be available for all Liberty HealthShare programs.

Additional links for direct primary care (DPC) information for patients and providers:

https://dpcnation.org

https://www.dpcfrontier.com/

https://dpcalliance.org

https://www.youtube.com/watch?v=eJYJPWpAX-Y&feature=youtu.be

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cost-reductionhealthcare-costsself-pay-patient