“My Personal Experience with Direct Medical Care and Dr. Ann O. Riggs”


EricCashinMy name is Eric.  I am a 48 year old male.  I have a history of chronic back pain, pre-diabetes,
recurring respiratory infections (at least annually) and many other miscellaneous health issues.  Last year I was diagnosed with coronary artery disease and had a stent placed in a major artery in my heart.

Because of my long history of health issues, having a skilled medical team and good health insurance has always been important to me and my family.

So why would I change from a traditional insurance based primary care facility to a practice using the direct pay model?

Best Doctor but Direct Pay?

I first became a patient of Dr. Riggs in 2012 when she worked for a traditional medical practice.  I was impressed with her knowledge, skill, and bedside manner.  I was cared for as a friend not just another patient to be pushed through the assembly line.  When she left the practice and started Direct Medical Care, I panicked.

She is the best physician I have ever worked with but how could I afford to pay her direct without using insurance?

A Light Came On

I was motivated to find a way to continue to have Dr. Riggs be my doctor. I began to

EricCashin2research what I had been paying out of pocket, what my insurance options were and how I could incorporate the direct pay model.

What I learned opened my eyes to the true costs of medical care.  It was like I had been sitting in a dark room and someone turned on a light.

Oh… I Think I’m Going to be SickEricCashin3

Being someone who prefers to make decisions based on sound analytical processes, I undertook the task to run a comparison between what my out of pocket expenses were with the standard medical insurance model and what they might be by marrying a High Deductible Plan with a Health Savings Account and membership at Direct Medical Care.  This is what I found out:

Out of Pocket Expenses

Actual(Standard Medical)


Comparison(HSA & Direct Medical Care)




This realization hit me like a ton of bricks.  Not only could I afford to join Dr. Riggs’ new practice, I could have saved $5,000.00!



How Is That Possible?
  • Changed to a High Deductible Plan with an associated Health Savings Account (my coinsurance dropped from 15% to 5%)
  • Insurance automatically contributes $1,500 per year into the HSA
  • Added another $2600 in HSA contributions (offset from prescription drug costs and change in dental plan)
  • All co-pays, co-insurance, prescriptions and membership in DMC paid for by HSA
  • Insurance reimbursed 65% of membership with DMC (net cost for annual family membership was $350.00)
Here Are The Numbers

DMC Membership, deductible, copay, co-insurance and prescriptions covered by $4,100.00 from HSA (no net change in monthly costs).EricCashin5

●     Save $700 family deductible
●     Save $475 on copays
●     Save $875 on prescriptions
●     Save $3,000 on co-insurance

Total Projected Savings $5,050.00

Not Just about $$

In 2013, after Dr. Riggs left the traditional practice (prior to getting DMC open) I began to see another doctor in that practice.  While this doctor was very capable, the assembly line medicine forced on physicians in these corporations caused my heart condition to be misdiagnosed for 6 months.

EricCashin6After joining DMC in December 2013, Dr. Riggs was able to determine that the symptoms I was having could be related to heart disease.  Her office scheduled an appointment with a cardiologist.  The condition was found and a blockage in my heart was repaired.  A potentially catastrophic heart attack prevented.

How Have The Numbers Worked Out?

In 2014,  I saved $7,522.23 compared to what I would have spent out of pocket on my old plan (that does not include the money DMC saved me by shopping prices and negotiating on my behalf for 2 tests – an additional $3,600.00 in savings).

My experience may be extraordinary, however, I am convinced that any individual or family will benefit from the superb medical care and cost savings found through joining Direct Medical Care.


Not everyone’s situation will result in the same savings that I have found.  But here are some examples of how DMC may make financial sense for you:

  1. I don’t have an HSA option where I work.
    • You can benefit by joining DMC and saving on copays and coinsurance for primary care services.  Additionally, membership costs count towards your deductible or may be covered by your insurance.
  2. I am in good health and never meet my deductible.
    • Fantastic, consider selecting a High Deductible plan and save on monthly premiums.  Savings will offset membership or you can join as a “non-member” and pay for a la carte services.
  3. I have Obamacare with a high deductible plan already.
    • DON’T WAIT!  You can’t afford not to join.

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Patient-Driven Affordable Healthcare


Direct Approach To Weight Loss


The New Year often brings renewed commitment to weight loss or healthier choices.

I spend a lot of my time as a physician counseling patients on how to approach weight loss.

wtmgt4What is the key to successful weight management?  It truly is simple.  You need to have a calorie deficit.   A calorie deficit is when your daily calories burned are greater than your calories consumed.

The difficulty is that the number of calories burned in a day is so variable from person to person.  We each have what is called our basal metabolic rate which is the amount of calories our body uses just sitting around.  A 200 pound muscular male may have a basal metabolic rate of 3000 calories per day while a 200 pound obese male may have a basal metabolic rate of 1200 calories per day.  Comparing diet plans to your neighbor should never be done.  Discovering the calorie deficit for you as an individual to successfully lose weight is the key.

I had a discussion with a registered dietician/personal trainer about a client who was gaining weight despite her great efforts in the gym.  She had her on an 1800 calorie a day diet.  I pointed out that her basal metabolic rate is probably too low to allow for 1800 calories.  If she wtmgt9is working out one hour in the gym and burning 600 calories during that time and her basal metabolic rate is 1000 calories, she will gain weight.  The proof was in her lack of weight loss, but she went ahead and pursued VO2 max testing.  This test evaluates oxygen consumption at rest and estimates your basal metabolic rate.  I was not surprised when her results came back at 800 calories per day.

There are always questions about tools to help with weight loss.  Yes, there are many things that can be used to help aid in weight loss, but they are only tools to help you do the fundamentals. We all know individuals that have had success with surgery or medicine only to regain the weight and more.  If you use the aids to help you eat good food in appropriate portions, you will have success.  When surgery or medicine is used as the solution rather than the aid, failure is likely.

I am a runner and have learned fundamentally that it takes time and energy, methodically wtmgt7putting one foot in front of the other.  I have tools to help make the process easier—good supportive running shoes, inspiring music, and an app on my phone to tell me good job as I go.  The truth is I still have to run.  Weight loss is the same.  You still have to do the fundamentals—remember calorie deficit.

So what should a good diet plan focus on other than the number of calories?    Real food and not processed food which includes fruits, veggies, lean meats, and dairy.   This should be the mainstay of your diet.

weightmgt6Poor diet choices cannot be compensated for by hours in the gym—the math just won’t add up for an appropriate calorie deficit. Exercise is good and necessary for a healthy lifestyle, but it is not the key to good weight management.


Ann Riggs, DO

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Patient-Driven Affordable Healthcare

Better Healthcare for Less Money

Time magazine has highlighted direct pay practices in the Dec. 29, 2014/Jan. 5, 2015 TimeMagdouble issue, “2015: The Year Ahead.”

I love the articles title–“Medicine Is About To Get PersonalTimeMagazine1

Better healthcare for less money:

“Make the patient, rather than the paperwork, the focus of the doctor’s day. The result will be happier doctors, healthier patients and a striking reduction in wasted expense.”




Ann Riggs, DO


Patient-Driven Affordable Healthcare

How the Adventure Began…

Every story has a beginning and this is Direct Medical Care’s…

Summer of 2013 was a major crossroads for me professionally as a primary care physician.  I contemplated where I wanted to take my career and ultimately weighed the three options I had–traditional, overseas, or private practice.

Option 1:  Stay in the traditional insurance based practice set-up where the focus was on insurance and its reimbursements rather than the patient.   A system that reimbursed by not only the number of patients seen but by the amount of unnecessary details I put in the patient’s office notedoctorwait.  I was expected to spend more and more of my time with regulatory compliance rather than patient care.  A visit about a broken toe required a discussion about end-of-life wishes, exercise goals, and smoking cessation.   The system was not ideal and job satisfaction poor, but the guaranteed income and sense of security was comforting.


Option 2:   Overseas medicine was very attractive to me.  What better way to escape the day-to-day battles of practicing traditional medicine in America than to go overseas?  The opportunity to experience a new system, different culture, and grand adventures was thrilling–it was Australia after all. AussieMy family was all on board with the idea but the details in that reality were overwhelming.  We would not get financially rich nor secure but sure to be rich with experiences.

Option 3:  To embark on private practice under the direct primary care model–a concierge practice for the masses.  Opening up a private practice as such was a huge Private Practice risk.  The financial outlay was significant and with student loans still to be paid, additional debt was daunting.  The projected struggle to pay for staff and overhead for the first 18-24 months added to that debt burden.  Concerns definitely existed for going against the status quo and expecting individuals to be open to a cash based practice. No wonder the whole idea was perceived as ludicrous by many, but the ability to truly care for patients and the professional satisfaction that would be derived from that was not to be overlooked.  Add to that the ability to decrease the healthcare costs for individuals and their families–it really was exciting to ponder.


I literally stood with three distinct paths to choose from–each had its pros and cons.  Was it the encounter along the running trail, the passerby at the grocery store, or the facebook message from a patient expressing their desire to see me stay in the community as their doctor? Most likely all of them, as I truly wanted to care for the people and the community that I had come to love–not to mention great staff that wanted the same.  The only viable and honest way to do that was by employing the Direct Primary Care model.

I am now one and a half years down the path and I have more conviction now that what I am doing is the right thing in the interest of true healthcare reform.  It is exciting and scary times in healthcare and we are happy to be moving forward as Direct Medical Care.

Ann Riggs, DO


Patient-Driven Affordable Healthcare