So…How Can I Get Reimbursed by My Insurance?
Disclosure: This blog is for general informational purposes only and does not constitute individual advice. Please consult a qualified financial, tax, or legal professional before making any decisions.
“The best kind of healthcare isn’t buried in paperwork—it’s built on access, trust, and time well spent.”
A common question we get at Ke Ola Noa is: “I have great insurance—can I get reimbursed for your services?”
The short (and admittedly unsatisfying) answer is: It depends.
Why Insurance Typically Won’t Reimburse for DPC Membership Fees
Most insurance payors do not reimburse for DPC membership fees. There are a couple of reasons for this:
No billing codes. There are currently no standard insurance billing codes for membership-style services, making it difficult to process through insurance systems.
Conflicting structures. Insurers want to be the exclusive recipients of recurring payments (i.e., your monthly premiums). Paying another provider a similar fee doesn't fit their model.
Yeah… bummer.
Five Silver Linings
1. Use a High Deductible Health Plan (HDHP) with an HSA
If you enroll in a high-deductible health plan (which often has lower premiums), you can pair it with a health savings account (HSA).
Thanks to the recent passage of H.R.1, starting in 2026, you’ll be allowed to use HSA funds to pay for Direct Primary Care membership fees—up to $150/month. This is a fantastic way to manage your healthcare expenses using pre-tax dollars, while keeping your insurance for major medical needs.
(See our previous blog post for more about this.)
2. Submit Superbills for Additional Services
While membership fees are typically not reimbursed, certain non-included services may be. These can include:
Small in-office procedures
House calls
Other one-time services outside the membership
Lab testing
Imaging
For these, we’re happy to provide a superbill—an itemized receipt that includes relevant CPT codes. You can submit this to your insurance for possible reimbursement.
3. Fewer Appointments Just for the Sake of Billing
In traditional healthcare settings, physicians often have to schedule in-person visits for things that could be handled with a simple phone call or email—just to trigger an insurance claim. In DPC, we don’t need a billable event to care for you. That means no unnecessary appointments, no missed work, and no copays just to get a refill. We meet you where you are—text, call, video, or in person—only when it’s truly needed.
4. Freedom from Reimbursement Chasing
While it may seem frustrating at first, not relying on insurance reimbursement can be liberating. You don’t have to chase down payments, file appeals, or track cryptic EOBs. Your time and energy are better spent on your health—not paperwork.
We’d much rather see you at a beach walk or yoga in the garden than arguing with your insurer.
Final Thoughts
Insurance can still play a critical role, especially in emergencies or major care situations. But for your everyday healthcare needs, DPC offers simplicity, access, and peace of mind—even if it doesn’t always come with an insurance claim form.
If you have questions about using an HSA, submitting a superbill, or understanding how our services fit with your existing plan, we’re happy to help point you in the right direction.
