Direct Specialty Care Alliance
What is Direct Specialty Care?
The Problem DSC Was Built to Solve
How Direct Specialty Care Works
- Set your own transparent fees
- Smaller patient panels — more time per patient
- No billing department, no claim denials, no credentialing
- Direct patient relationships governed by a legally binding Direct Care Contract
- Practice in-person, telemedicine, or both — across all licensed states
Know your cost before you book. Pay your specialist directly. No insurance middleman between you and the care you need.
This type of care is useful for one-time or acute needs (e.g. same or next-week consultation, pay one flat fee agreed upfront — no insurance claim filed by the physician) or chronic or ongoing conditions, where you can chose to pay a membership model (e.g. covers a set number of visits, direct physician access — call, text, or message, urgent visits, regular monitoring and care plan adjustments etc.)
Labs, imaging, and medications may be covered by your existing healthcare insurance or ask for the cash price. Many DSC physicians offer direct cash pricing with local labs and imaging centres. You choose — insurance or cash, whichever costs less. The patient decides. Not the insurer.
How Does Direct Specialty Care Compare?
|
Direct Speciality Care |
Insurance-Based |
Concierge Medicine |
|
|
|
|
|
|
| Transparent pricing before visit | Always | Rarely | Partial |
| No surprise bills | Yes | Common | Common |
| Specialist-only care | Yes | Yes | Mostly PCP |
| No prior authorization | Yes | Required | Sometimes |
| You choose cash or insurance for labs | You choose | Insurer decides | Insurer decides |
| Affordable for most patients | Yes | Variable | Expensive + insurance |
| Same / next-week access | Often | Months wait | Often |
| Physician accountable to patient only | Yes | To insurer | Partial |
| No annual high retainer fee | Yes | Yes | $2,400–$6,000+/yr |
| Specialist focus (not primary care) | Yes | Yes | Mostly primary care |
Frequently Asked Questions
Direct Specialty Care is a model where you pay your specialist physician directly — through a transparent flat fee or monthly membership — instead of going through insurance. The physician sets a clear price upfront. You know what you’ll pay before your first appointment. There are no prior authorizations, no claim denials, and no surprise bills.
A Direct Care Contract is a simple, legally binding agreement between you and your specialist — defining your relationship before care begins.
It covers:
- Your fee — flat, monthly, or annual
- The services and visits included
- How and when to reach your physician
- Terms for ending the relationship
- The fact that no insurance company is party to this agreement
It does not replace your health insurance.
It replaces only the insurer’s role in your specialist relationship. Your insurance stays active for labs, imaging, hospitalizations, and medications. You choose when to use it.
The DSC model is not new. Direct Primary Care proved the concept over two decades — smaller panels, more time per patient, better outcomes, lower burnout. Direct Specialty Care extends those same principles to specialist medicine.
In 2020, the first Direct Specialty Care practices launched — proving the model works even in the most complex specialties. Others followed.
The DSC Alliance was founded that same year to formalise the movement and build the community independent specialists needed. The DSC Alliance was founded on one principle — medicine works best when the physician’s only obligation is to the patient. Not to an insurer. Not to a hospital system. Not to a billing quota.
Direct Specialty Care is not a workaround. It is medicine the way it was meant to be practiced.
Search our growing national directory of board-certified DSC physicians.
DSC works best for:
- Patients on high-deductible plans already paying out of pocket for specialist visits
- Anyone who has been waiting months for an appointment and cannot wait any longer
- Patients managing chronic conditions who need ongoing access — not rushed appointments
- Self-employed individuals and small business owners who want predictable healthcare costs
- Patients whose preferred specialist is out of network
- Anyone who needs a thorough second opinion
- Employers looking to offer quality specialist care without insurance overhead
No. You keep your health insurance for labs, imaging, prescriptions, and hospitalizations. Your Direct Care Contract only covers your specialist relationship. In fact, many DSC patients carry standard health insurance for everything else — DSC simply removes the insurance middleman from the specialist visit itself.
Concierge medicine charges a high annual retainer fee ($2,400–$6,000+) on top of your existing insurance premiums, and most concierge practices focus on primary care — not specialists. DSC is specifically designed for specialist physicians — rheumatologists, cardiologists, neurologists, and more — and is priced to be accessible to most patients.
Each DSC physician sets their own transparent fee structure based on their specialty and the type of care offered. Fees vary by specialty and care model (consultation vs. membership). All DSC Alliance member physicians publish their fees before you book — so you always know the cost upfront. Use the Find a Specialist directory to browse physicians and their fee structures.
In most cases, yes. Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA) can typically be used for direct care membership fees and consultation costs. We recommend confirming with your HSA/FSA provider, as rules can vary. This is one of the reasons DSC is particularly attractive for patients on high-deductible health plans.
DSC Alliance member physicians practice across rheumatology, cardiology, endocrinology and diabetes, neurology, psychiatry, podiatry, ENT/otolaryngology, vascular medicine, hematology, oncology, and palliative care. The directory is growing as more specialists join the Alliance.
Yes. Direct Specialty Care is legal in all 50 US states. Specialist physicians may legally opt out of insurance contracts and charge patients directly. Many DSC physicians also opt out of Medicare through a formal private contracting arrangement. The DSC Alliance provides legal guidance and resources to support physicians in navigating their specific state’s requirements.
The term Direct Specialty Care was introduced in 2020. Dr. Diana Girnita, a board-certified Rheumatologist and Internist, launched one of the first DSC practices in the US — Rheumatologist OnCall — in 2020, and co-founded the Direct Specialty Care Alliance along with Dr. Lara Kenney Briseno, a hematologist and oncologist, to build the community and resources that other specialists needed to make the same transition.