Direct care as a concept isn't a new idea, but in the era of HMOs, PPOs, Co-pays, co-insurances, and major conglomerates and CEO making healthcare decisions that impact millions, a doctor, like myself deciding to go the direct care route can be seen as radical, or even extreme.
In the United States, before the days of insurance plans, people simply paid their doctor directly, similar to how every other service is performed, without an intermediary. Think of how your hair stylists, plumbers, electricians, gardeners, lawyers, accountants, and the list goes on get paid for the services they provide.
It is no secret that the state of healthcare in the US is in a very scary place currently, for both doctors and patients alike. Just go online and you see daily reports of another strike at a hospital from healthcare workers including doctors and nurses, who are fed up with the abuse and exploitation that happens daily at these health institutions.
I know, without a doubt that direct care is one of the ways the healthcare system in this country can be saved, and this is why my practice, Direct Podiatry Arizona has a direct care model. A direct care practice is one that does not bill or is not contracted with any insurance plan. Your doctor provides a service, or treatment, and is paid directly by you the patient. This is different from concierge practice which charges a retainer free on top of billing insurance for additional access to the doctor. There are many benefits to choosing a direct care doctor for your care, but here are my top 12.
Table of Contents:
1. No rushed visits with your doctor
Every year, reimbursement or payments from insurance companies to doctors decreases. At the same time the amount of money it takes to keep a practice open increases. So what do many doctors in the insurance model have to do? They have to see more patients. More patients in the insurance model means more revenue to a certain point. This hurts both doctors and patients. And this is not sustainable.
Patients are usually forced into a 7-15 minute visit with their doctor. Patients also can be double booked during one appointment time meaning, that if for example, you have an appointment with your doctor at 9 am, it's very possible that your doctor has one or even two other patients, in addition to you, also scheduled at 9 am. This leads to very short visits with your doctor, even rushed visits because your doctor now has to run from room to room to complete these visits. It's very unlikely that your problem can be fully addressed in 7-15 minutes, and this leads to understandably frustrated patients. This is known as assembly line medicine and hurts everyone involved, doctors and patients. The practice of medicine is a practice in human relationships. There has to be a level of humanity there coming from the doctor to the patient, for this relationship to be a healthy one, and I believe for the treatment to be successful. Unfortunately, in the era of HMOs and PPOs, many patients are viewed as a diagnosis code, a dollar reimbursement, or a time slot.
In the direct care model, because the doctor is paid directly by the patient, without insurance interference, the doctor can spend as long as they would like with the patient, to be sure that all of their concerns are addressed. Direct care doctors don't have to double or triple book patients in order to meet their overhead, so you know when you walk into a direct care office, it's just you and the doctor during that appointment slot, that's it.
2. Your doctor has the time to truly get to the root cause of your problem
One of the complaints that many patients, and even doctors like myself about the Western medicine model is that disease prevention is not at its core. Yes, in the modern era we do have screening tests for certain diseases, but even if said test is positive, what tangible help does the patient receive to be able to reverse that disease state, or just to lower their risk? Western medicine though is great for addressing problems quickly to save a person's life or prevent disability like surgery for a broken leg, or heart bypass in the case of cardiovascular disease.
For example, as a foot doctor, I see many diabetic patients, because diabetes does attack the feet leading to many foot problems, and even amputation or death in the worst-case scenario. During my training, patients with ulcers for example, or just high blood sugar were told to lower it, and what would potentially happen over time if they didn't, but not once were these patients counseled on HOW to lower their blood sugar and keep it in a healthy range. Lifestyle changes were never discussed, just more medications given. And forget the patients that had a family history of diabetes, that watched a mom, dad, sister, or brother go through amputation after amputation, and eventually die from this disease. Understandably so they didn't want to go down that road themselves, but more often than not, no tangible advice was given to these patients from a doctor.
Doctors in the insurance model with crushing overhead, and consistently lower payments from health insurance plans are unlikely to have the time to do this.
If a patient is interested in truly preventing disease states, having a direct care doctor on your team is ideal. Doctors in direct care again have the time and freedom, because they aren't contracted with insurance to really dive deep into your health history, thoroughly go over lab results, counsel you, and monitor you on lifestyle changes to give you a better quality of life. Unfortunately, all of this is impossible to do in a 7-15 minute appointment time.
3. You are able to get an appointment with a direct care doctor much faster
Direct care offices see a much smaller number of patients in a day than offices that accept insurance. Because of this, it can be very difficult for an insurance-based practice to accommodate last-minute appointment changes, especially if the patient's life and limb is not at risk. For example, before I opened Direct Podiatry Arizona, I had a job as a mobile podiatrist, traveling to nursing homes, group homes, and assisted living facilities all across Maricopa County. One of my new patients on this particular day just so happened to have an infected ingrown toenail. Even though she called several podiatry offices to make an appointment, they were booked, and couldn't see her for four months. Yes, four months.
Direct-care doctors see a fraction of what a doctor in the insurance-based model has to see, which means that it is much easier for direct-care doctors to make changes or accommodations to their schedule for patients late minute, even offering same-day appointments.
4. Your wait time is minimal to none when you arrive at a direct care office
Rightfully so, one of the major complaints from people seeing their doctor is the amount of time you have to spend in the waiting room waiting, once you get to the doctor's office. We all, myself included have made the effort to schedule the appointment with your doctor. Maybe you've even had to take time away from school or work to get to your appointment on time. And then, you are left waiting for an added 30-45 mins, an hour, or even up to two hours (I saw many patients waiting for 2 hours or more during residency).
Is frustrating, and personally, I think is disrespectful to the patient's time and energy. With the tables turned, in a lot of the practices if you are more than 15 minutes late as a patient, your appointment is canceled, and you have to reschedule, taking even more time, energy, and money from your life. Granted, doctors in the insurance model don't have patients wait on purpose. The long wait times are due to the volume of patients a doctor in this model has to see (at minimum 20-25, but can be 30-40 patients a day), with double and triple booking patients causing these bottlenecks and time, and long waits.
A direct care practice typically has a much lower overhead than a practice that bills insurance. Direct care practices don't need billers, coders, billing software, or hire staff to go after claim denials from insurance companies. Because of this, not nearly as many patients need to be seen by a direct care doctor to keep their doors open. In a direct care practice, the amount of time that a patient waits in a waiting room is minimal (maybe 15 mins tops) to none. Many direct care doctors are able to meet their patients at the door once they enter the office, myself included.
5. Patients without insurance are treated exactly the same as every other patient
In a perfect world, everyone would be treated equally, but even in medicine, this is not the cause. In Arizona, as of 2021, 800,000 people were uninsured. [1]. Patients who are uninsured at times can be turned away from doctors' offices in the insurance model, or even if they are seen at these offices, they potentially are not offered the same treatment options as patients with health insurance due to the inflated prices and lack of price transparency that comes with healthcare under the insurance model.
At direct care practices all across the country, and here at Direct Podiatry Arizona, I want anyone reading this without health insurance to know, that this practice is a safe place for you to know, and know that you are getting the same level of treatment and care, because direct care practices are out of network for all insurance plans.
6. If you have health insurance, your visit and treatment possibly can still be reimbursed by your health plan.
If you are someone that does have health insurance, depending on your treatment or procedure, your health insurance plan can reimburse you for your visit to a direct care doctor. This is extremely helpful for people who have insurance coverage but don't want to deal with some of the issues listed above and continuing below on being seen in a practice that accepts insurance. Ask your direct care doctor if they will give you a superbill, a special itemized receipt detailing your visit. You will then give this superbill to your insurance company. To learn more about reimbursement from your insurance plan, call the company and have them go over the process of getting this done, and ask them about what treatments and procedures can be reimbursed because not all can,
7. Your treatment plan isn't dictated by what insurance plan you have
Patients are usually surprised to hear this, but for a doctor in the insurance model, insurance definitely dictates what treatments or procedures can be given to patients. Health insurance does not cover everything, even when other treatments have not worked for you. Insurance companies are unfortunately notorious for denying claims, or outright not covering certain medications treatments, or procedures.
The hands of doctors practicing in the insurance model are tied because even though most want to do the best they can for their patients, the best treatment or procedure insurance might not cover. What is a patient to do?
This is why direct care doctors are so needed. There needs to be a place where the patients can go, that unfortunately have fallen through the cracks of the insurance-based model can have their concerns addressed through direct care practices and doctors that aren't tethered to insurance regulations and mandates.
8. The price for your visit + treatment is transparent and straightforward
The average price for a single, 40-year-old to carry health insurance in 2023 is $560 per month [2]. This never means that you pay your monthly premium and then you are covered. Other costs often come up when visiting your doctor, and these include:
Co-pay - a dollar amount that you have to pay every time you are seen by a doctor, could be as little as $25 but could be upwards of $200 for an outpatient visit.
Deductible - Your deductible is the dollar amount you have to pay out of pocket before your insurance benefits kick in. This number ranges and depends on the type of insurance you have. For commercial plans, a deductible can be as little as $2000 to upwards of $15000. Yes, so this means for example if you have an insurance plan with a $15,000, for insurance to pay for anything relating to your care, you have to pay an additional $15,000 out of pocket, on top of your monthly premiums.
Co-insurance - Even if you meet your deductible let's say, there are stipulations on how much insurance will pay for a treatment, procedure, or service. This is called a co-insurance and usually is a percentage. Again, this will be different from plan to plan. Some insurance plans, after meeting your deductible will cover the treatments and procedures that they cover at 100%. Sometimes insurance will cover these things at 80% meaning that you're left to pay the remaining 20% out of pocket.
Between co-pays, deductibles, and co-insurances, seeing a doctor in the insurance model can become very pricey, and lead to many unexpected bills. People with high deductibles are functionally uninsured [5]This is because even though they do carry a health plan, they will have to pay out of pocket and meet their astronomical deductible before insurance will start to pay for anything. Especially if you are young, healthy, and aren't in a catastrophic accident, the likelihood that you will meet your deductible year to year is little to none.
At a direct care practice, you the patient know exactly how much the visit, procedure, or treatment will cost ahead of time. The pricing fees for direct care practices are very straightforward because they are the same for everyone. No insurance benefits need to be verified. Because of this, it is much easier to make an informed financial decision when seeing a direct care doctor.
9. A direct care visit oftentimes is cheaper than having your health insurance billed for the same visit
People are usually surprised to hear this, but yes, often times a visit with your direct care doctor is often cheaper than a visit with a doctor in the insurance-based model. Once you add up the cost of your monthly premium + deductible/co-insurance + co-pay, 1 visit can cost thousands of dollars, for something routine or basic.
In the direct care model, because there are no inflated prices set by health insurance companies, this cost savings can be passed down to you the patient. You, the patient are paying for the supplies, the doctor's knowledge, expertise, space, maybe support staff if they have it, and time, that's it. Not for the million-dollar yearly take-home pay of health insurance CEOs. To learn more about the health insurance CEOs that brought in record-breaking 283 million dollars in 2021, click here. [3]
10. You have more innovative treatments and therapies available to you at a direct care practice
For example, let's say you have plantar fasciitis. You have tried all of the conservative treatment options like stretching, icing, orthotics, physical therapy, changing your shoes, and orthotics. You've even tried steroid injections, which might not have worked.
Your doctor in the insurance model offers you surgery in a last-ditch effort to get rid of the plantar fasciitis for good. But you're hesitant to go the surgery route for many reasons, whether it's just not wanting something as invasive as surgery done, maybe it's difficult to take time off work or school, maybe you have a lot of responsibilities at home that you need to be present for. Maybe you aren't the right candidate for surgery due to your health history. What are you doing to do?
At a direct care doctor's office, because they aren't contracted by insurance, a direct care doctor can offer treatments and procedures that work just as well, if not better than the treatments that insurance companies will pay for, and get you back on your feet. For our plantar fasciitis example, this could mean PRP, stem cell injections, or shockwave therapy.
A direct care doctor gives patients a wide array of treatment options for their health concerns, without the restrictions of insurance, leaving no stone unturned on the road to solving your health problems.
11. Your doctor is easier to access
Imagine calling your doctor's office, and you are immediately connected with your doctor. Or leave a message at your doctor's office, and they personally call you back the same day. This is all commonplace in a direct care practice. Here is why.
The average number of patients that a direct care doctor has on their panel (the number of active patients in their practice) is about 500. A direct care doctor can see 1 - 12 patients a day. This is very different from the average 2500 patient panels that a doctor in the insurance-based model has.[4]. Because direct care doctors aren't seeing anywhere the volume that a doctor in the insurance-based model is seeing, questions, and concerns can be answered directly, and in a timely fashion. No phone trees, no other staff speaking on behalf of your doctor, and you've got direct access to your doctor with any questions or concerns you have.
12. Happy and healthy doctors make for happy and healthy patients
Again, medicine is a healing art. We as doctors lay our hands on our patients day in and day out, to bring healing and renew health. Energy is transferrable, positive or negative. Ever walked into a room after two people have argued, and you feel the tension without a word having to be said in your presence? Attended a one-year-old's birthday and you feel the love, joy, and celebration in the air.
It will be much harder for doctors that are run down, burnt out by working in the insurance-based model, questioning or regretting their decision to become doctors to truly address your problem. You cannot pour from an empty cup, no matter how much you want to.
A doctor that is happy, physically, mentally, and spiritually, is more likely to be present during your visit, to take the time to get to know you and your concerns, to not rush, and to offer all treatment options available, or to refer you to someone with those treatments available in order for you to regain your health.
The End
Direct care is a return to tradition and returns humanity back into medicine, one of the oldest, and most well-respected, highly revered practices in society. My direct care practice allows me to practice medicine in the way I always dreamed of since I decided I wanted to become a doctor at the age of 8. It is my honor, to be a direct care doctor and a direct care specialist. To find direct primary care doctors in your area, visit the DPC Mapper which lists direct care practices all across America. To find direct specialty care doctors in your area, visit the Direct Speciality Care Alliance.
Schedule Your Appointment At Direct Podiatry Arizona Today
Looking for a direct care doctor or direct care specialist in Arizona? My name is Dr. Sondema Tarr, I am a board-certified foot doctor, and am the proud owner of Direct Podiatry Arizona in Tempe, AZ. To view my available appointment times, or for a free consultation, click here.
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