Direct-Pay Healthcare: Good for Doctors, but Buyer Beware

Instead of dealing with traditional insurance, co-pays and deductibles, Dr. Christina Bovelsky has her patients pay a one-year membership fee that includes an annual physical exam, between 2-4 office visits as well as various tests such as strep tests and electrocardiograms. Care for children under 18 ranges from $20-30 per month while adult patients pay between $65-75 per month. The fee amount varies based on the number of visits a patient would like to have per year and any additional visits cost $80 each beyond their included amount.
A 2014 Survey by the Physicians' Foundation found that 7% of doctors are currently running a direct-pay practice and another 13% plan to transition to some form of direct-pay model.  Many healthcare providers are also looking to transition because they are able to spend more time with fewer patients, which allows them to really identify the cause of a medical issues instead of ordering extra tests. Additionally, doctors are more readily available to patients after hours in a direct-pay model, but even with the extra attention, some fear the model will drive up medical costs for unsuspecting individuals. Insurance representatives stress that consumers should make sure that they fully understand a direct fee plan and the cost of treatments from a physician who is not working within a traditional insurance plan network.
As doctors age, they tend to want to scale back and a direct-pay practice allows them to slow down, make house calls, and ultimately decide their own schedule. Additionally, a direct-fee model helps doctors and patients eliminate lengthy paperwork from insurance companies. Not to mention it can also eliminate the insurance standards that so often dictate what services can be provided as well as for how long they can last such as physical therapy.

In the direct-pay model, doctors decide those standards . Furthermore, the time saved from not having to deal with insurance hurdles allows doctors to really focus on their patients and create better visits in the end. "The average time a doctor has with a patient is 7 minutes," Bovelsky said, "Here, it is at least 30 to 60 minutes. Sometimes it's 90. When you take the time to sit down, you are going to find the answer to what is going on with them... the way medicine is set up currently... it really is a revolving door.” When you add everything up and eliminate having to deal with insurance companies, it is a whole lot cheaper to run a direct-pay healthcare program. However, patients should still be very aware of all the costs involved in switching to this model, since while it certainly has its benefits, various high costs can arise when they least suspect them. 

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