If It Talks Like Insurance and Walks Like Insurance: The Curious Case of Direct Primary Care Arrangements

For decades, elite “concierge” practices have been providing easy access to primary care in return for several thousand dollars in retainer fees. Recently we’ve seen the emergence of more affordable versions of this arrangement, with monthly fees that cost far less than the average ACA marketplace plan premium. At first blush, these arrangements, frequently called “direct primary care arrangements” (DPCAs), might seem like a way to ensure access to health care services in the face of rising health insurance premiums. CHIR’s Maanasa Kona explains why this is not always the case. Continue reading

Filing Fee and External Appeals

One of the most significant consumer protections in the Affordable Care Act (ACA) is the right to appeal a denied claim, including the right to take your appeal to an independent, third-party reviewer. Although the ACA guarantees this right, recent federal rules have codified barriers to the process that still exist in some states, such as filing fees. Sandy Ahn provides a short summary of this issue. Continue reading