Once upon a time…
if a person became sick, he or she might call up the doctor, who would show up at the doorstep. The doctor would diagnose and treat the issue, check back in a day or two for follow-up, and be available on call if further issues arise. As one can imagine, the doctor would charge a fee for his services, although legend has it that the doctor’s care would be available to everyone in town… not just to the wealthy.
Today, there is a prevailing mindset that in order to see a doctor, a patient has to have insurance. No insurance, no doctor. Is that true? Why does it have to be that way?
It may surprise you to learn that it doesn’t.
Have you heard of “third party billing”? Many have, but don’t really know what it means. In health care, there are two main “parties”: (1) the patient, and (2) the health care provider. Third parties are entities who pay for and are therefore involved with care, apart from the provider and the patient. These are the health care plans, which of course include insurance, as well as government-subsidized plans such as Medicare or Medicaid. The understood process is that patients pay into the health plans, whether through premiums or taxes, then the health plans pay the medical providers. Unfortunately, it is not that simple, and things are only growing increasingly complex when these third parties are involved.
Enter: Direct Primary Care
Because the complexity of health care has become essentially universal (in other words, it is complicated everywhere), it seems impossible to simplify it. But in fact, it is quite possible. Just remove the third party. When the financial relationship between the patient and the provider is direct, so is the health care relationship – which is the way it was always meant to be. Doctors who don’t have to spend exorbitant resources communicating with health plans —surprise, surprise— have more time and resources to spend just caring for patients. We are doctors, not business-folk. Caring for patients is all we have ever wanted to do. By charging a monthly or annual membership fee that generally costs less than a TV or cell phone bill, Direct Primary Care (DPC) practices can provide around-the-clock availability, relaxed and thorough office visits, personalized attention, and in many ways, actual cost savings to their patients.
Frequently Asked Questions
Don’t doctors with cash-paying practices only cater to the wealthy? I can’t afford that.
Contrary to how it appears on the surface, Direct Primary Care (DPC) is not the same as Concierge Medicine. Depending on a few factors such as age and medical needs, fees typically range between $50-$150 per month nationwide. At Thrive APC, our monthly fee costs less than most cell phone, internet or TV bills. Also, we have family discounts, referral rebates, and discounts for college students, military, veterans and first responders. We promise: it is much more affordable than you think.
What are the benefits of membership?
Membership includes all primary care services such as a complete annual physical, routine labs, virtually unlimited sick visits (up to 60 per year – hopefully you won’t need that many!), chronic disease and medication management, home and hospital visits, all with in-person same-day or next-day access, and a direct line for communication by phone, text, email, and even video chats. No co-pays, no co-insurance, no hidden or back-door costs for any primary care services we can provide. Also there is no minimum commitment and no contract. Our goal is to make it simple again to get care. We believe it can be done, and in DPC we prove our belief by being the ones who do it.
What about major health expenses, like tests, surgery or hospitalizations?
Expenses like this should be covered by health insurance, and DPC membership should not be confused with having health insurance. The example of car insurance is often used to shed light on this distinction. In most states, it is illegal to drive a car without insurance. But there is also a simple understanding of what it is meant to cover, which generally means something bad happened, such as an accident or perhaps a cracked windshield. That’s the nature of what “insurance” was meant to be: a failsafe or backup when there is a disruption in the natural order of things. There is value to having it there when you need it because problem can and do arise. But car insurance does not cover your oil changes, tire rotations, windshield wipers, or interior detailing — in other words, prevention and maintenance. On that vein, health insurance is needed to cover larger health expenses like those mentioned in the question. Primary care manages prevention and maintenance, and DPC does so with easy access at a stable, predictable, affordable cost.
I have a high-deductible insurance plan. How can membership at Thrive APC help me save money?
With high-deductible insurance, essentially all medical costs up to a certain dollar amount (variable according to the plan) are paid for out of pocket by you, the patient. Over 90% of care needed by most patients can be addressed in the primary care setting. Membership helps to keep these needs freely available without the worry of incurring additional costs. Apart from this, cash costs for other common tests or needs outside of the scope of Thrive APC, such as X-rays or colonoscopies, will be negotiated on behalf of our members. More information on this to come.
Can I enroll at Thrive Adult Primary Care if I have Medicare? Mass Health? An HMO plan?
The answer to all of the above is Yes, as long as it is understood that membership with Thrive APC is not covered by any of these plans. It is an additional expense to any/all of the above. Health care with a DPC practice can actually reduce monthly or annual health care costs, but it may involve changing your coverage plan; this is an individual decision that would need to be looked at one-on-one. Patients interested in this analysis should feel free to contact the practice to discuss.
Can I use my Health Savings Account (HSA) or Flexible Spending Account (FSA) to pay for my membership?
Because we do not accept any payments directly from third parties, coverage through an HSA or FSA would have to be worked out as a reimbursement to you. Whether the membership fee would be covered depends on the rules of your individual HSA or FSA, so our advice would be to contact your benefits manager to discuss, and we would be happy to look at it with you as well to figure this out.
Is it worth it? I’m healthy enough, I rarely need the doctor and I already have insurance, so why bother?
If you become or perhaps an elderly family member becomes unexpectedly ill, do you want to sit for hours in the E.R. waiting room, or call your doctor’s office only to be on hold for half-an-hour then be told that there is no availability for weeks? Or would you prefer to pick up the phone –perhaps even initiate a video chat through Skype® or FaceTime®– and be greeted by the voice (or face) of a medical expert you have come to know and trust? But the best way to determine the value of our service is to come check us out. If you are having difficulty getting in to see your regular doctor, feel free to come for a single visit, experience the difference, then decide for yourself.