Montana Lawmaker Introduces Direct Patient Care Bill


A Montana state lawmaker today introduced a bill that would formalize a patient’s ability to directly pay a doctor for care without insurance. Similar bills have been vetoed in the past.

Republican Sen. Cary Smith of Billings told the Senate Business, Labor and Economic Affairs Committee that direct patient care lowers provider overhead costs and simplifies the health care experience by sidestepping insurance companies, and state and federal regulations.

“The consumer ought to be able to choose what they want to buy rather than having the bureaucrats telling them what they need to buy,” he said.

Under Senate Bill 101, a patient would have the option to pay a monthly fee in exchange for agreed upon services from a health care provider.

Former Republican state Auditor Matt Rosendale allowed direct patient care without regulatory oversight with a memo in 2017. But Smith said his bill is necessary to expand the model to dentists, chiropractors and other providers, and to codify direct patient care in case future auditors don’t support it.

There are currently eight direct patient care clinics in Montana, according to bill supporter Kendall Cotton with the free market think tank Frontier Institute.

After the bill hearing, Smith stressed that direct payment is intended for routine or preventative care, and that patients should still have health insurance to cover catastrophic events, like a car accident or cancer diagnosis.

University of Montana economist Bryce Ward in an interview said direct patient care may lower administrative costs for doctors who don’t have to file paperwork with insurance companies, but patients need to pay close attention to what services they’re agreeing to pay for.

“That’s basically the main catch. I pay you this amount of money thinking I’m going to get X, then I go to get X and you say ‘No, no, no, we’re talking about Y, not X,’” he said.

The Legislature passed similar direct patient care bills in 2015 and 2017, which former Democratic Gov. Steve Bullock vetoed, saying the system allows providers to charge fees for treatment already covered by insurance.

Jackie Jones, representing Republican Auditor Troy Downing, was one of 10 people who testified in support of the proposal.

“We need more tools for people. The model of health insurance and doctor doesn’t work,” she said.

John Doran with Blue Cross and Blue Shield of Montana was among the bill’s three opponents Wednesday, but said the insurance company would support the proposal with an expected amendment that would prevent providers from billing both through direct patient care contracts and insurance companies.

The committee hasn’t yet scheduled a vote on Senate Bill 101.


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