Direct Primary Care can save patients money and at the same time, offers unprecedented ease of access, transparency and higher quality of care. Direct Primary Care is a win-win scenario for both patients and the providers both of whom are released from the draconian control of insurance companies.
An article in the New York Times October 17, 2015, “Unable to Meet the Deductible or the Doctor“, detailed the issue of having insurance with a high deductible but being unable or unwilling to pay out of pocket costs for primary and specialty care. This development in the insurance world is becoming increasingly common as over 7 million people are now covered under the Affordable Care Act with plans that offer low monthly premiums, but out of reach deductibles.
The standard “bronze plan” on the Maryland health exchange now comes with a $6,000 deductible for a family plan. For healthy individuals who rarely need to see the doctor, a standard “free” comprehensive physical can run from $200-$500, depending on the types of in-office testing needed. It doesn’t matter that you have insurance- everything you pay comes out of your own pocket until you meet that deductible. Multiply that price for a physical exam by the number of people in your family, and you’re likely still not at that deductible yet. Add in a few acute care visits, and you might be getting closer. While having insurance and being protected from catastrophic medical debt is most certainly better than not having that coverage, the relatively healthy individual with a high deductible plan may be discouraged from seeking primary care at all.
In fact, Evolve Direct Primary Care has worked out a number of very steep discounts for common tests, procedures, X-rays and MRIs.
In this increasingly common scenario, it can be quite expensive to even consider having primary care needs met, let alone specialty care. An answer to this insurance cost conundrum has arisen with the development of direct primary and urgent care centers. These direct pay medical homes have traditionally been referred to as “concierge” practices, but the newer models offer affordable pricing and convenient access for patients, where members pay between $35-$50/month which enables them to low or no-cost office visits. Price lists with additional cost for services or medical procedures are given to patients at the time of sign-up, so they know exactly what they’re paying ahead of time. Patients have easy accessibility with their providers through the phone, email, or in many cases, virtually in secured visits over the internet.
These models allow primary care doctors to cut overhead in a setting where insurance payments have remained stagnant and administrative costs have jumped. Many providers in traditional care settings feel exasperated by billing exchanges with insurance companies, and consequently report a negative affect on their relationships with patients. Adding in affordable care through a direct pay practice allows for preventative screening, acute visits, and maintenance of chronic medical conditions while you hold your high deductible insurance plan for catastrophic events.
Learn more at Direct Primary Care.org’s website.
Kastle F. Donovan, RN, MSN, CRNP-F
Michael R. Freedman, MD
Evolve Direct Primary Care