Curative Wants in On DPC With a Few Stipulations

I was sent an email thread by Cliff Porter, MD, PhD, who runs Texas Direct Medical Care. Curative, which is a health plan, states nothing about Direct Primary Care on its website, but it is licking its chops to get a piece of it.

Has DPCNews come across Curative’s efforts to suck DPC into their network at rates at or below Medicaid reimbursement?  I am planning on writing an article on it.  They cold emailed me a contract offer for my own clinic (Texas Direct Medical Care) and other Texas DPC colleagues.  It is amazingly clueless about DPC, and I have Dino images from DPCNews dancing in my dreams. I have the contract offer, fee schedule, and email string on their sales pitch. It is quite something.

The emails are long so Cliff summarized it here:

Curative insurance is offering DPC clinics the opportunity to join their insurance network. Curative offers fully insured business plans with no copays or deductibles for employees.  A Curative representative is emailing DPC clinics offering this opportunity, which is an insurance wolf in DINO clothing.  The representative is seemingly unaware of my thoughts on insurance, so I started asking more questions, and it was very revealing.

     From the first introductory email, the representative told me, “[DPC] aligns well with Curative’s mission…. Since your practice recommends that members carry major medical coverage alongside their DPC membership, a Curative contract would be a natural complement.…”  And, “We would like to invite you to join the Curative network directly through a participating agreement with Curative.  This will ensure that your patients enjoy the benefits of our $0/$0/$0 plan designas we build our direct network.”

     Curative is offering direct payment to DPC clinics based on the Curative fee schedule.

     Beware. What they offer is at worse a ruse, a misdirection, a bait and switch, or maybe simply clueless.

     There are several problems, so I asked a few questions for clarity about reimbursement rates and how this fee for service “complements” DPC.

     First of all, the fee schedule is based on CPT codes at sub-Medicare rates.  Office visits are 75-90%, so 99213 is $93 and 99203 is $115.  We are installing x-ray, and they will reimburse a CXR at $21, 65% of Medicare.  Cash prices range typically $50-75, sometimes cheaper, for same x-rays. Insurers are charging the plan or business (if self-funded) often $100-300.  Curative did not let on how much they charge a business client.  

     Secondly, I asked how Curative works with DPC, and they let it out of the bag, 

“How FFS Billing Works with a Membership-Based Clinic: This is a great and important question. Here’s how it works:

• For Curative members, you would bill Curative on a standard fee-for-service basis using CPT/HCPCS codes, just like any other in-network provider. Curative pays you directly at the contracted rate for each service rendered.
• Membership fees cannot be required for Curative members to access covered services. In other words, a Curative member would come to your practice, receive care, and you would bill Curative for the visit — without requiring them to pay a separate monthly membership fee for access to those covered services.
• Your DPC membership model continues as-is for your non-Curative patients. Nothing changes for the rest of your patient panel.
• You accept Curative’s contracted rate as payment in full — no balance billing Curative members beyond their plan cost-sharing (which, under Curative’s $0 plan design, is typically $0).”

     The Curative representative then promised, “But paired with the guaranteed payment, growing Curative membership in the Austin area, and zero administrative hassle on collections, the economics work out well over time.”  To translate, Curative is offering higher volume to compensate for low-ball reimbursements.  They just don’t get it; we left BUCA world and came out of the cave of shadows and darkness for a reason.

     I further asked what DPC’s had signed up, and they said that was confidential – not a great sales pitch.  Another question was adjudicating claims denials that was answered with wonderful promises to be good and they had an excellent appeals process. 

     Having worked with Curative covered patients already, trying to get medications and procedures approved (such as a cardiac stress test) has been a challenge.  In several cases the Curative representative told us we are not allowed information on prior authorization rejections even though we are the primary care physicians for our patients.  It seems such stonewalling information is not for patient medical care, but more about denying payments.  The prior authorization system and claims submission is different than other BUCA’s and is cumbersome.  Many specialty clinics in our area have stopped accepting Curative altogether.  I am not confident the promises from Curative are well grounded and they ring a bit hollow. 

Thanks so much, Cliff, for sharing!!!

Has anyone else had an interaction with Curative? Or other similar companies? Do you want to share your experiences?

In summary: