The current US Healthcare model looks a little something like this. You have health insurance, through work or via a personal plan. Many plans have a fairly high deductible that you need to pay before the plan starts to cover any part of many services. Let’s say you get sick and go to your doctor. Once there, you have a co-pay, which is money you always pay and isn’t part of your deductible. If you need a prescription, you often have a co-pay, still not going towards your deductible. Several weeks later, you get a bill from the doctor’s office for the balance of what your insurance company didn’t pay. If you have a $5000 deductible (which is very common), you’ll end up paying for the entire visit every time you get sick until you reach that dollar amount. This is while you’re still paying a monthly premium in addition to all of these extra charges!
Some doctors are trying to improve healthcare by going the cash-pay route, including direct primary care. This allows them to keep their costs low because they don’t have to hire someone to work with insurance companies and jump through all the hoops associated with that. The doctors can also have more control over the services they offer and how much they charge.
Without the need to spend their time satisfying insurance company requirements, cash-pay doctors such as direct primary care providers can spend more time with their patients. They keep a smaller roster of patients which means flexible appointment times and more time with the doctors themselves. Imagine being able to text your doctor with a health concern! Enhanced communication is very common with direct primary care. Finding a direct primary care provider near you is the first step to establishing a new kind of relationship with your doctor.
One benefit of working with a clinic like Oregon Health DPC is the price transparency. Regular visits are covered by the monthly membership, and you have access to discounted fees on everything else. Rather than be surprised with a bill weeks after your visit, you’ll know upfront how much additional services will cost. According to a review of pricing options offered by dozens of healthcare providers, more doctors, hospital networks, and treatment centers are touting big discounts for patients who pay cash upfront and forgo using their insurance.
Reduced fees for paying cash are more common for diagnostic procedures, such as MRIs, X-rays, and ultrasounds, but cash payers can also often get a better deal for direct pay lab tests, prescription drugs, out-patient surgeries, and therapeutic services, such as physical therapy. Even surgical centers are getting onboard, developing bundled packages for common procedures. At cash-pay surgery centers, procedures are often 40% to 60% less than the same surgeries elsewhere. Having insurance companies out of the picture makes routine healthcare more efficient and affordable.
Something to keep in mind is that money spent on a membership does not go toward your insurance plan deductible or out-of pocket maximum. We suggest patients look into the availability of a Flexible Spending Account or Health Savings Account. An FSA/HSA may be able to pay for your membership fees and can be used for other medical expenses that may go toward any deductible you may have. However, like homeowner and auto insurance, health insurance protects you from financial shocks that could bankrupt you if you or a family member has a medical crisis that requires major hospitalization or expensive treatments. Even with a direct primary care membership, you should still carry major medical insurance to cover the bigger or more catastrophic events. Even with the monthly premiums, having a cash-pay membership saves you so much more!
When working with a cash-pay doctor like Oregon Health DPC, you can expect more personalized visits, appointment flexibility, discounted services, and price transparency. When compared to traditional healthcare with rushed visits that often take months to schedule and result in surprise bills, the benefits are clear. Because they have the time and freedom to do so, direct primary care doctors can develop a comprehensive treatment plan that truly addresses the patient as an individual, rather than spending their time meeting insurance company requirements.
As a direct primary care provider near Portland, Oregon, Oregon Health DPC is looking forward to contributing to an enhanced wellness program for our neighbors!