In a pivotal win for Direct Primary Care (DPC) providers and patients alike, Wisconsin has officially passed Senate Bill 4 (SB4), making it one of the most DPC-friendly states in the country. This legislation provides much-needed legal clarity for DPC agreements and represents a forward-thinking shift in how primary care is regulated and delivered.
At its core, SB4 recognizes that Direct Primary Care is not insurance. It carves out a regulatory safe harbor for providers and patients who choose to enter into flat-fee, subscription-based healthcare arrangements. In doing so, it empowers physicians to practice medicine with autonomy and allows patients—especially those without insurance or with high-deductible plans—to access affordable, transparent, and consistent care.
What SB4 Does
SB4 defines and legitimizes DPC agreements by setting specific criteria they must meet to be exempt from insurance regulations. These include:
- The agreement must be in writing and signed by both the provider and the patient (or employer representative).
- It must clearly define the services included, subscription fee, duration, and termination terms.
- It prohibits billing insurers for services covered under the agreement.
- It mandates that patients be informed in writing that the agreement is not health insurance.
- It enforces protections against discrimination, ensuring that providers can only refuse care under specific conditions (e.g., full practice, service mismatch).
These provisions remove ambiguity for providers and patients, protect consumer interests, and reinforce the integrity of the DPC model.
Why This Matters for DPC Practices
For independent physicians and clinics operating in or transitioning to DPC, SB4 is a game-changer. One of the biggest hurdles for many DPC providers has been the legal uncertainty around whether DPC agreements constitute insurance products. SB4 eliminates this confusion.
FlexPerx has long advocated for a clear and supportive legal framework that empowers doctors to escape the constraints of fee-for-service and reclaim their ability to provide meaningful care. With SB4 in place, Wisconsin physicians can confidently:
- Launch or grow a DPC practice without fearing reclassification by the insurance commissioner.
- Maintain predictable revenue through monthly memberships.
- Focus more time on patients and less on paperwork.
- Offer a sustainable, transparent, and scalable care model.
This law brings to life many of the core teachings from DPC University, especially Module 2 on legal compliance. It’s a textbook example of how clarity in legislation can unlock innovation and restore trust in healthcare.
Why It Matters for Patients
SB4 is equally important for patients, especially those underserved by traditional insurance models. For individuals who are uninsured, self-employed, working part-time, or between jobs, DPC offers a much-needed lifeline. The legislation gives patients more options to receive continuous, proactive care at a price they can understand and afford.
Under SB4, patients gain:
- The right to a written agreement detailing exactly what care is included.
- Assurance that their DPC provider isn’t beholden to insurers.
- Legal protection against discriminatory refusal of care.
- A way to access consistent care without navigating insurance bureaucracy.
This aligns perfectly with the FlexPerx mission: to make healthcare more affordable, accessible, and human. By removing red tape, SB4 makes it easier for patients to choose providers who prioritize relationships, not reimbursement codes.
FlexPerx Applauds the Legislators Behind SB4
We commend Senator Cabral-Guevara and Representatives O’Connor and Rodriguez for their leadership in championing SB4. Their bipartisan support reflects a shared commitment to innovation, transparency, and patient empowerment.
As Rep. O’Connor noted, the bill is part of a broader strategy to reduce unnecessary regulation, improve healthcare access, and strengthen local economies. Rep. Rodriguez emphasized the importance of patient choice and clarity in the doctor-patient relationship—values that are foundational to the DPC model.
Legislators who prioritize healthcare transformation deserve recognition. SB4 is a clear demonstration of what happens when policymakers listen to providers, understand patient needs, and act with courage.
Where SB4 Excels
The bill gets a lot right:
- Legal Certainty: By stating that valid DPC agreements are not insurance, SB4 removes the chilling effect of regulatory ambiguity.
- Patient Protection: The bill includes safeguards against discrimination and requires full disclosure to patients.
- Physician Autonomy: It allows DPC providers to set their terms, accept or decline patients based on capacity and scope, and practice without interference.
These are foundational principles for any thriving DPC environment.
Where It Could Improve
As strong as SB4 is, there’s room to grow:
- Startup Support: The bill doesn’t include incentives or funding for physicians looking to transition into DPC. Grants, tax breaks, or educational subsidies could accelerate adoption.
- Telehealth & Tech Integration: The law is silent on modern tools like virtual care, chronic care management platforms, or digital prescription services—key components of many DPC offerings.
- State-Backed Public Education: There’s no mandate or funding to educate the public about DPC. Increased awareness could help more patients discover this option.
FlexPerx and its partners will continue advocating for these enhancements, ensuring DPC continues to grow as a smart, scalable alternative to the broken status quo.
A Model for the Nation
Other states should take note. Wisconsin’s approach is thoughtful, practical, and patient-centered. By clearly defining DPC and protecting it from misclassification, SB4 sets a replicable standard for states seeking to improve access, reduce costs, and support independent providers.
At FlexPerx, we’ve already seen interest from states like Texas, Florida, and Ohio in advancing similar protections. We urge lawmakers across the country to use SB4 as a legislative blueprint and work with local physicians, patients, and advocacy groups to modernize primary care.
Let’s Scale This Movement
SB4 proves what we’ve known all along: when doctors are free to focus on care and patients are free to choose affordable, transparent options, everyone wins.
FlexPerx stands ready to support any state that wants to follow Wisconsin’s lead. Through DPC University, DPC Pro, and our national network of partners, we offer the tools and training needed to bring this model to life.
- To the physicians of Wisconsin: congratulations on your new path forward.
- To the patients: better care is now easier to access.
- To lawmakers in other states: it’s time to catch up.
Let’s fix healthcare—one state at a time.
