Why Choose Direct Primary Care? Comprehensive FAQs

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Q&A

FREQuently asked questions

What is Decent?

Decent is a third-party administrator headquartered in Austin, Texas. We specialize in administering level-funded health plans for groups down to 5 lives, designed around the Direct Primary Care (DPC) model.

What is Decent?

What is the Direct Primary Care model?

Direct Primary Care (DPC) is a healthcare model that focuses on a direct relationship between patients and their primary care providers. Gaining tremendous popularity in recent years as a way to address some of the challenges in the traditional healthcare system and provide more patient-centric, value-based care. Typically patients pay a monthly fee or subscription directly to their primary care provider, however, with a Decent Health plan, DPC is included. No deductibles, no copays, no claims.

What is the Direct Primary Care model?

How does DPC work in a Decent plan?

With a Decent plan, your care starts with seeing an in-network Direct Primary Care provider or DPC. Think of it like having a doctor in your family who will get to know you and your health. When you get your care through your DPC, it's free to you.

How does DPC work in a Decent plan?

WIth a Decent plan, your care starts with seeing an in-network Direct Primary Care provider or DPC. Think of it like having a doctor in your family who will get to know you and your health. When you get your care through your DPC, it's free to you.

Why are Decent plans built around the DPC model?

To provide better healthcare at a lower cost. Your DPC is paid to focus on you. This way, they can truly act as your quarterback of care.

The DPC model leads to healthier members. Healthier members mean Decent is able to administer health plans at a lower cost. That means lower costs and better care for all our members.

Why are Decent plans built around the DPC model?

To provide better healthcare at a lower cost. Your DPC is paid to focus on you. This way, they can truly act as your quarterback of care. The DPC model leads to healthier members. Healthier members mean Decent is able to administer health plans at a lower cost. That means lower costs and better care for all our members.

How can I work with Decent?

Email us at dpc@decent.com, swing by www.decent.com/direct-primary-care or give us a ring at 1-888-DECENT-9 to get the ball rolling.

How can I work with Decent?

What if I don’t use a DPC?

If you seek care outside of a DPC, your Decent plan will still work like a good traditional health plan with a deductible. You can still get all of the coverage you need, but at additional cost.

If you continue to seek care that isn't coordinated through a Direct Primary Care provider (outside of your Pediatrician and OBGYN), your Decent plan offers the following standard coverage: decent.com/plan

What if I don’t use a DPC?

If you seek care outside of a DPC, your Decent plan will still work like a good traditional health plan with a deductible. You can still get all of the coverage you need, but at additional cost. If you continue to seek care that isn't coordinated through a Direct Primary Care provider (outside of your Pediatrician and OBGYN), your Decent plan offers the following standard coverage: decent.com/plan

What group sizes does Decent serve?

Decent serves groups with 5 or more enrolled lives. Our minimum group size varies based on state laws. There is no maximum group size.

What group sizes does Decent serve?

Decent serves groups with 5 or more enrolled lives. Our minimum group size varies based on state laws. There is no maximum group size.

What geographies does Decent serve?

Decent can serve employers and members nationwide.

What geographies does Decent serve?

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What sets Decent apart from other health plan options in the market?

Decent stands out as an innovative group health plan solution with its focus on the Direct Primary Care model, and a sincere commitment to providing the best rates and service. We're dedicated to creating a positive and unique experience for employers, members, and advisors. We may not be the best option for everyone, and we will tell you when we’re not.

What sets Decent apart from other health plan options in the market?

What are my out of pocket costs?

Members who choose preferred options can get all their care for free ($0 out of pocket). If you prefer to work with an out-of-network provider, you may, and a $3000 deductible, coinsurance, and Rx copays will apply.

See our plan page for more information: decent.com/plan

What are my out of pocket costs?

What's the difference between a DPC and a Primary Care Physician (PCP)?

PCPs typically see a large number of patients each day, and spend less time with their patients on average than a DPC.

DPCs can treat and manage all the same medical issues that PCPs do. They do not submit claims to your insurance. (That’s us!) Instead, we pay your DPC a part of your monthly premium simply to be your primary care provider, regardless of how often you need to see them.

What's the difference between a DPC and a Primary Care Physician (PCP)?

Which PBM (Pharmacy Benefit Manager) does Decent use?

Decent partners with DisclosedRx as its PBM.

Which PBM (Pharmacy Benefit Manager) does Decent use?

What do I do if I get a bill from my doctor or a hospital?

You are only responsible for any applicable copays, deductibles and coinsurance of your plan. If you have questions regarding a bill you have received, please contact us immediately by calling 1-888-Decent-9.

What do I do if I get a bill from my doctor or a hospital?

Which TPA (Third Party Administrator) does Decent use?

Decent partners with Edison as its TPA.

Which TPA (Third Party Administrator) does Decent use?

Who is the stop loss for Decent plans?

Decent leverages a panel of A-rated domestic Stop Loss carriers to ensure the best rates for groups.

Who is the stop loss for Decent plans?

How does Decent underwrite groups?

Decent's panel of stop-loss partners employs multiple AI underwriting tools to return quotes within a few days. Notably, we do not require health questionnaires or claims experience data for a binding quote.

How does Decent underwrite groups?

How does Decent handle claims fund surplus for groups?

In order to provide the lowest possible rates and maintain superior service, Decent retains aggregate funds not spent on claims.