Patient Options DMCO – Provider FAQs
This page answers common questions from healthcare providers evaluating Patient Options DMCO as a compliant framework for offering self-pay and cash discounts alongside insurance, Direct Primary Care (DPC), and concierge medicine models.
General Overview of Patient Options
What is Patient Options DMCO?
Patient Options is an independent Discount Medical Care Organization (DMCO) that enables providers to offer contractual, compliant cash discounts to self-pay patients.
Unlike traditional Discount Medical Plan Organizations (DMPOs), patient participation is free, and Patient Options is not insurance, an HMO, an indemnity plan, or a payer. The organization does not sell memberships to patients and does not assume financial or insurance risk.
Is Patient Options health insurance or a substitute for insurance?
No. Patient Options is not health insurance and does not replace, bill, or interact with third-party payers. Providers may continue to bill insurance as usual for covered services, if they choose. Patient Options applies only to eligible self-pay services.
Who benefits from Patient Options?
Patient Options is designed to benefit both providers and patients by:
Supporting compliant self-pay pricing
Reducing reliance on informal or ad-hoc discounts
Improving access to care without patient enrollment fees
Compatibility With Modern Care Models:
Does Patient Options work with Direct Primary Care (DPC) practices?
Yes. Patient Options provides a full service approach to DPC practices- compliant, profitable contracts with patient members as well as helping providers offer extra services outside their traditional DPC membership plans.
Can concierge medicine practices participate?
Yes. Concierge practices may use Patient Options to offer compliant discounts for services inside or outside their concierge retainers or subscriptions, while maintaining clear pricing separation.
Is Patient Options compatible with hybrid practices?
Yes. Patient Options is structured to support hybrid practices serving insured, uninsured, self-pay, DPC, and concierge patients within the same office—without interfering with insurance billing.
Compliance and Regulatory Considerations:
How does Patient Options help address dual fee schedule concerns?
Patient Options provides a documented, third-party discount framework that allows providers to offer consistent cash discounts without provider-owned pricing differentials—helping reduce exposure to dual fee schedule allegations.
Have Patient Options providers ever been challenged by payers?
Yes. third party Payers, patients, state boards, and state insurance regulatory bodies have all raised dual fee schedule concerns with our clients before. We have a track record of 100% successful defense, when Patient Options was used as structured. Those matters were all successfully resolved through documentation and program design, because we separate the doctor from the discount, and we administer all the regulatory measures
(Past outcomes do not guarantee future results.)
Has Patient Options been reviewed by state insurance commissioners?
Yes. Patient Options has been reviewed by multiple state insurance regulators and found compliant with applicable laws. Because patients are not charged fees, the program does not meet the criteria of a regulated insurance, indemnity, or DMPO product.
Is Patient Options registered as insurance in my state?
No. Patient Options is not insurance, does not sell to patients, and does not charge enrollment fees—placing it outside typical insurance registration requirements.
Provider Participation and Fee Schedules:
Are providers required to change their fee schedules to participate?
No. Providers retain full control over their fee schedules, pricing, and clinical decisions. Any fee schedule changes must be applied consistently across patients.
Can providers offer bundled, membership or capitated pricing?
Yes. Providers may establish:
Line-item CPT pricing, and/or
Clearly defined capitated (not-to-exceed) visit fees, provided the services included are documented in the fee schedule.
- membership pricing in compliance with their applicable state laws
Is there a limit on how much providers can discount?
Patient Options encourages reasonable and consistent pricing, but discount amounts are ultimately determined by the provider.
Can Patient Options discounts be used for copays, coinsurance, or deductibles?
No. Patient Options discounts apply only to self-pay services and may not be used to offset insurance cost-sharing obligations.
Medicare and Government Programs:
Can Medicare patients participate in Patient Options?
Yes. Medicare beneficiaries may participate.
Can discounts be offered for services not covered by Medicare?
Yes. Providers may discount services not covered by Medicare, such as maintenance or wellness care, provided proper documentation (e.g., ABNs) is maintained.
Patient Participation:
How do patients enroll in Patient Options?
Patients enroll by signing a free participation agreement at a participating provider’s office. There is no membership fee.
Do patients need proof of participation before receiving care?
No. Enrollment documentation is maintained by the provider and Patient Options. If both are in place, the patient is eligible.
Practice Growth and Value:
Why should providers join Patient Options instead of traditional DMPOs?
Providers choose Patient Options because:
Patients are not charged enrollment fees
Providers are not required to sell memberships
Discounts are contractual and documented
Administrative burden is minimal
The program supports compliance-focused growth
What does provider participation cost?
Provider participation is $99 per month per location. additional providers are no charge.
How large is the Patient Options network
As of mid-2025:
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1,200,000+ patient participants
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1,700+ participating providers nationwide
Important Compliance Notice
Patient Options DMCO does not provide legal advice and does not guarantee immunity from audits or enforcement actions. Providers should consult qualified healthcare counsel regarding regulatory compliance.