Direct primary care (DPC) is a health care model that allows individuals to pay a monthly, or sometimes annual fee, to a primary care provider in exchange for health care services. Individuals who have a health maintenance organization (HMO) plan often face roadblocks when attempting to use DPC services as HMO plans require individuals to stay within a specific network of providers. Since DPC providers are considered out-of-network by HMO plans, coverage is often denied for labs, imaging, or specialist care that is ordered by a DPC provider, even when the lab, imaging, or specialist is in the HMO network.
 
It is for these reasons that I will be introducing legislation that would require the Pennsylvania Secretary of Health and the Commissioner of the Pennsylvania Insurance Department to establish regulations to allow direct primary care providers to submit referrals for individuals covered under HMO plans. In doing so, this legislation would help reduce unnecessary delays, increased costs, and burdens on individuals who are looking to receive safe and high-quality care.
 
Please join me in co-sponsoring this important legislation to ensure broader access to comprehensive health care services for residents across Pennsylvania.