When people hear out-of-network care, some might freak out.
The thought of having to pay additional out of pocket expenses for medical care is a contentious one. Those who pay into private health insurance are paying on average $500 per person per month, with a deductible of upwards of $5000 or more. For those of us who are new to insurance plans, some people are unknowingly choosing to purchase a plan with low co-pays but trade that for a higher deductible.
To break it down simply, that means the insured would need to spend their own dollars until they accumulate $5000 worth of eligible expenses (the deductible) before their insurance will pay for benefits. For those who rarely utilize medical services, they may also never reach the deductible within the calendar year and what does accumulate will reset every 12 months.
Doesn’t that seem like a lot of money to pay out of pocket into a plan that doesn’t work until you spend more? So basically the insured is paying at least $5000 into the insurance plan per year, or as someone else has said it before, the insured is effectively uninsured until they pay up.
Doesn’t this seem like a lot of money to pay out of pocket into a plan that doesn’t work until you spend more? Click To Tweet
That’s not even the crazy part about privatized health insurance in the U.S. Let’s get into where that money goes with a real case example my patient had.
A woman in her late 30s needed corrective bunion surgery due to pain with daily activities. The surgery was performed at a local hospital and her out of pocket expense came to $9000 even with “good” insurance. The total I received for my services was about $800. The patient did very well and had a beautiful outcome.
When it came time to do the other foot, I started questioning the system. Why is it that I carry 100% of the malpractice risks and am fully responsible for the aftercare but got only 10% of what the patient paid?
Why is it that I carry 100% of the malpractice risks and am fully responsible for the aftercare but got only 10% of what the patient paid? Click To Tweet
Hospital services are incredibly essential for nonelective surgeries. There are many people to pay from the receptionist, nurses, orderlies, technicians, anesthesiologists, OR staff among others. When it comes to elective surgeries, however, I wondered if I could provide direct care instead where I streamlined my care to just the patient, me and one additional support staff, save the patient money and preserve hospital services for more urgent cases, all at the same time?
Turns out, the answer is yes.
Direct Care is a social movement by doctors who are fed up with the restriction of insurance and have opted out of insurance plans simplifying access to medical care at a more economical rate that works for both patients and doctors. The premise is if someone wants a service, they pay that person directly, just like any other service industry. Only in medicine has it been normalized to not pay the doctor in full and on time. Direct Care is the antithesis to this and offers a litany of benefits to patients because it puts patients in control of where they spend their dollars.
Benefits of Direct Care Podiatry (and most specialties):
- Increased quality of care. When doctors get paid their full amount and on time, they can run their business more efficiently without delay and without having to double or triple book appointments. This improves the patient-physician relationship and leads to longer appointment times rather than the average 7 minutes in insurance-based practices.
- More affordable. Costs are clear which supports market competition. When prices are transparent, patients can shop around and budget accordingly. Actually, when removing insurance entirely, medical care becomes more affordable because the middleman no longer has a job to push papers. Price transparency also forces others to increase their value to stay competitive. Currently, people who use their insurance are dealing with surprise bills, which means no one knows the cost of anything until after the fact. This has forced many Americans to file for bankruptcy and it deeply fractures patient’s care and harms them financially.
- Physicians love practicing medicine again. The majority of physician burnout is related to job unfulfillment and loss of autonomy. What’s typical of insurance-based practices is seeing 30-40 patients in a day, followed by hours of charting, coding and doing non billable work. In Direct Care, seeing 8 to 12 people a day is typical and is enough to sustain a practice. Overhead expenses are cut, increasing the profit margins while improving patient care. This is the dream private practice many doctors thought medicine would be like when they applied to medical school many decades ago. Happy doctors stay in medicine, while unhappy doctors leave.
- Preventive care oriented. A lot of preventive care is not part of insurance benefits. Doctors who adopt Direct Care are intimately involved with a patient’s long term wellness because it’s a direct relationship. An added bonus is that many Direct Care doctors are often available to their patients after usual work hours. Having direct access to the doctor can save trips to the urgent care center or emergency room.
For many who rarely utilize medical services, it makes financial sense to spend money as needed, rather than into high insurance premiums. Having Direct Care as an option means patients can decrease their insurance premiums downgrading to catastrophic plans and reserve their cash for less urgent care, like elective surgery.
Direct Care does not replace catastrophic health insurance so if patients need lab work, advanced imaging studies, prescriptions, referrals, or durable medical equipment, the respective facilities can still bill the insurance.
When I learned about Direct Care, I knew I needed to adopt it. Although I don’t wish to offer the cheapest care, after all who really wants cheap surgeries, I can give high quality care at reasonable rates which is better for patients and for my business. Opting out of insurance means I set my rates and receive it at 100% and it’s paid on the same day the service was rendered.
I also had to unlearn some of the expensive habits from training like learning what cases would be more appropriate in the office setting versus the hospital. Looking back, a lot of surgeries performed in the hospital were only done in the operating room because “it paid better.” Insurance influences patient care, even in residency training, and unfortunately contributes to unnecessary increases in medical expenses. It really doesn’t have to be this way.
Direct Care is another way to deliver and receive medical care. I highly recommend it.