Patients - Become a person, not just a number or disease. Lessen the frustration of your experience in healthcare, trust that your care is complete, AND put money in your pocket.
With traditional managed care insurance, your doctor does not work for you. Physicians work for your insurance company. The insurance company chooses the physician's salary and provides their paycheck. From 2001-2003, primary care physicians saw 25% more patients and saw no increase in pay when adjusted for inflation (1). This is why access is more difficult, office visits are shorter, and the visits are more hurried. You are often forced to wait excessively in the doctor's office for your appointment when a phone conversation might do. Unfortunately, insurance companies won't reimburse phone calls.
Your insurance company makes decisions, instead of you, once you've given them your money. Valuable new testing like coronary calcium scoring and fractionated cholesterols are "not reimbursable" by many insurances even though the information could help determine your heart disease risk and whether medication is necessary. Also, some of the best health providers won't be in network with insurance because of low reimbursement.
The solution: Hire a doctor, not an insurance company.
A direct practice physician charges $100-$200 monthly; less than a daily coffee and bagel. You will have easy access to your doctor 24/7 by e-mail and phone, including their personal cell phone. They can care for 85% of your problems and you will have a trusted advocate to be your quarterback, helping you navigate our complex medical system. You need a doctor who will worry about you when problems arise.
This sounds expensive. It's not.
Purchase a High Deductible Health Plan (HDHP) to protect you when unexpected problems arise. Singles save about $2500 yearly and families save over $7000 (2). Take the money saved from the insurance premium and put it (pre-tax) into an HSA. See below to learn more about HDHP/HSA.
Your direct practice physician can negotiate deeply discounted rates on x-ray and lab services, as well as special testing (stress tests, colonoscopies, etc.) as seen in Table 1 below. Costs are often less than managed care companies can get. Medical facilities are very willing to deeply discount their fees when cash is paid at the time of service (a simple swipe of an HSA debit card). The facilities avoid the hassle of collection process, delay in payment, and uncertainty that the bill will even be paid.
Most patients will have money left over in their HSA at the end of the year to roll over to the next. That money will earn interest and can be used when bigger problems arise.
|
Test |
Retail Cost |
Cost to Managed Care Insurance |
Negotiated Cost fo Payment at Time of Service |
| Abdominal ultrasound |
$260 |
$180 |
$156 |
| PSA |
$111 |
$20 |
$8 |
| HSCRP (measure of cardiac inflammation) |
$115 |
$35 |
$12 |
| VAP (fractionated cholesterol) |
$179 |
$95 |
$39 |
Table 1 - Comparative costs of services - Bucks County, PA
This may sound like an unusual insurance model, but it is the way most insurance works. The purpose of homeowner's insurance is to cover the cost of big problems when they arise, like fire or theft. When upkeep of your home is needed like purchasing a new furnace or having siding replaced, you expect to hire a reputable contractor and pay them. Homeowner's insurance does not get involved. You make the decision and get the quality of work desired. Competition among the contractors drives quality service and prices.
Why don't I hear more about HDHP/HSA? Insurance brokers are paid a commission based on your monthly premium. The typical HDHP will cost 1/4 to 1/3 as much as a traditional managed care insurance plan. Consequently, the broker's commission is much less.
Contact a direct practice physician today and take control of your health. Encourage your employer to offer a HDHP as an option and give you the premium savings in an HSA + cash.
Resource:
(1) Primary Care Physicians are Caught in Productivity Squeeze, American Medical News, 20 Sep 2004. 47 (35): 1.
What are HDHP/HSA?
High Deductible Health Plans (HDHP) - Health insurance that typically has a deductible of $2,000 - $3,000. After the deductible is paid, the insurance covers 80-100% of additional costs. There is a maximum yearly out-of-pocket cost you incur.
Health Savings Accounts (HSA) - An interest earning account obtained through a bank that can only be used for healthcare expenses. Deposits are made pre-tax just like an IRA. Most major banks offer them now and funds can be accessed by writing checks or swiping a debit card. The account must be tied to a HDHP.