When the Doctor’s Family Needs Medical Care
Giving Up Traditional Insurance
Mind-Blowing Healthcare Savings–$$$$
My traditional high deductible healthcare insurance plan I carried in 2016 was increasing from $820.00 per month to $2100.00 per month with an even higher deductible.
I was looking at an annual premium cost of $25,200.00
When we made the transition to the cost sharing program with Liberty HealthShare in 2017 it made sense as long as we were healthy. The cost savings were profound. We opted for their top coverage: Liberty Complete
With the Liberty HealthShare option we chose we have an annual registration fee of $75.00 and pay $449.00/month for our family of four.
I was now looking at an annual “premium” of $5,463.00
Now we had a few medical bills in 2017:
- an MRI for my husband’s shoulder $240.00
- a screening mammogram for me $200.00
- remember I am a family practitioner so some minor coughs/colds etc. would be handled by me that we will account for $500.00
Our general out-of-pocket expenses for the year were around $940.00. Let’s round that number up for a few other incidentals and we are at $1000.00 for the year.
So our first year savings came out to almost $19,000.00
So year two brings on a different twist as we have a medical need arise. Craig’s MRI and poor response to conservative therapy leads to major surgery. We researched our options and chose the Surgery Center of Oklahoma.
Our annual “premium” is still $5,463.00
Craig’s Surgery and Rehabilitation Costs:
- Surgical Consultation: $200.00
- Surgery Center of Oklahoma: $5,749.00*
- Continuous Passive Motion(CPM) Chair: $775.00
- Physical Therapy: $540.00
*includes surgeon fee, facility fee, and anesthesia fee
Liberty HealthShare Shared Amounts(reimbursements):
- Surgical Consultation: $200
- Surgery Center of Oklahoma: $4,249.00
- CPM Chair: $0
- Physical Therapy: $0
Our final unshared(out-of-pocket) amount we were responsible for was only $2,815.00
So in two years after leaving traditional health insurance we will have saved about $35,000 with a major event occurring
If I still haven’t convinced you…
Now let’s go back to the traditional insurance world…the national average projected cost for arthroscopic shoulder surgery with one of the major insurance carriers in the United States is:
- Facility and Anesthesia Fee: $16,150.00*
- Surgeon fee: $8,985.00
- Total: $25,135.00
*based on outpatient surgery, national average for inpatient surgery increases that fee by $11,000
In contrast the fair pricing found with the Healthcare Bluebook
Why didn’t I leave traditional insurance sooner?!?!?!?!?!
This is true healthcare reform with patient-driven affordable healthcare.
Ann Riggs, DO
When the Doctor’s Family Needs Medical Care
My husband Craig had been complaining about his right shoulder hurting the summer of 2017. To be the spouse of a doctor can be challenging because getting my attention medically can be tough at home.
We had tried conservative care with ice and ibuprofen for months. We tried cold laser therapy. We even tried steroid injections with minimal relief. He had significantly modified his activities due to the pain.
The final straw: he could no longer play catch with his daughters.
We got an MRI of his shoulder scheduled. Our cash pricing through our Midwest Direct Primary Care Alliance was $240.00 cash at a local free-standing imaging clinic.
The MRI revealed no full thickness tear of the rotator cuff but there was a partial tear with joint effusion and chronic tendinosis and tendinopathy.
I consulted an orthopedic specialist online through Rubicon MD who recommended surgical evaluation over continued conservative care.
An online referral was started with the Surgery Center of Oklahoma.
In January 2018 Craig was set-up for a surgical consult late Thursday afternoon with anticipated surgery the following Friday morning in Oklahoma City. We braved the typical January weather from KC to OKC.
After reviewing Craig’s case, the anesthesiologists/owners of the Surgery Center of Oklahoma hand-picked Dr. Couppens as the surgeon. This former US Olympic team doctor met with Craig and modified the surgical plans with him given the magnitude of adhesive capsulitis(aka frozen shoulder) that had developed.
The next morning we arrived bright and early for surgery. While Craig was being attended to I got to enjoy the company of Dr. Keith Smith and Dr. Steven Lantier the masterminds behind the Surgery Center of Oklahoma and the pioneers in the movement for price transparency.
The surgery was deemed a success and we drove home later that day. The road to recovery included lots of rehabilitation over the next several months and we are now happy to report Craig is once again playing catch with his daughters.
Ann Riggs, DO
Giving up Traditional Health Insurance
I had blogged about them and had seriously considered them–cost sharing plans.
I resisted giving up my traditional health insurance because of the beauty of the triple tax savings with the Health Savings Account(HSA) that I married to my high deductible plan. I saw such value in that piece that I lost out on the bigger picture–saving money without sacrificing care.
I paid for my daughter’s surgery out of pocket in 2016 when the cost for the negotiated insurance pricing was higher than actually just paying cash.
I saved almost $1200 by paying cash. Click to see the details in my previous blog.
My traditional high deductible healthcare insurance plan I carried in 2016 was increasing from $820.00 per month to $2100.00 per month.
The plan was not only going up by $1280.00 per month but it offered less coverage and had a higher deductible.
The decision to move to the cost sharing plan was easy at this point. We chose to go with Liberty HealthShare
Our cost became $450.00 per month for our family of four and our out-of-pocket portion or unshared amount(deductible) became $1500.00 annually.
Ann Riggs, DO
On the eve of Dr. Parker’s first day in the clinic at Direct Medical Care I thought it only appropriate to share a little more information on her. Check out her bio:
Dr. Parker was born and raised in the Kansas City area. She is one of six children of Dr. and Mrs. C. Phillip Pattison who reside in Weston, Missouri. After spending her freshman year of high school at Shawnee Mission Northwest she moved with her family to Rolla, Missouri where she graduated from Rolla High School in 2001. She returned to Kansas City later that year to attend the University of Missouri-Kansas City, School of Medicine. Upon graduation, she was chosen as the recipient of the Society of Academic Emergency Medicine Award. Dr. Parker spent one year at the University of Indiana Emergency Medicine Program in Indianapolis. After a year of Emergency Medicine training she chose to return to her passion for primary care medicine. She completed a residency in Family Medicine, followed by a Fellowship in Geriatric Medicine at St. Vincent Hospital. During her time in Indianapolis, Dr. Parker married her husband, Dr. Matthew Parker, and had three sons. Dr. Parker and her family returned to the Kansas City area in 2013 and they reside in Weston, Missouri. She was employed as a Family Medicine physician at the Cerner Corporation through August 2017. During her time at Cerner she was the recipient of multiple patient service excellence awards. Dr. Parker chose to pursue a new path in medicine by joining Dr. Ann Riggs, Beckie Moore, and staff in her Direct Medical Care clinic in January 2018. Dr. Parker is thrilled to be providing affordable, comprehensive, and most importantly, compassionate care for her patients.
Welcome to Dr. Parker and her family to Direct Medical Care and our community!
Ann Riggs, DO and Staff
Cori is an avid football fan and is loyal to our Kansas City Chiefs. Last spring she set out on a transformation that has changed her life.
Not only does she look fantastic but she feels healthier and happier with her progress. She is a mother of three active children and is excited to be setting a good example for them by being healthier and taking care of herself.
Cori’s encouragement for others is to be prepared for hard work. The results will not be instant and expect setbacks. It really is about making small steps towards a bigger goal.
How did she do it? Hard work. Nothing compensates for hard work. She began running and really watching her diet. Her diet focus was not only about healthier choices but also portion control. Cori has completed two half-marathons and has plans for more.
Go Cori and Go Chiefs!
Ann Riggs, DO
I recently had the opportunity to experience the pitfalls of my own commercial health
insurance. I tell patients all the time “the proof is in the pudding.” Well it was my turn to see how this pudding really was in the health insurance world.
This past fall my daughter was hit with yet another bout of strep throat. She has fought it throughout her young life. At the age of seven I made the call to consult with one of my favorite ENT docs. It was an easy decision that she would do better if we proceeded with tonsillectomy and adenoidectomy.
I, like so many of my patients, have a high deductible plan that I have married with an HSA(Health Savings Account). I knew the bulk if not all of the cost of the procedure would be my responsibility. I did not hesitate to ask for cash pricing.
Insurance Negotiated Pricing vs Cash Pricing
Pricing for any surgical procedure needs to include the following fees:
- Surgeon’s Fee
- Anesthesiologist’s Fee
- Surgical Facility’s Fee
INSURANCE NEGOTIATED PRICING:
|Anesthesiologist + Facility||$2624.00|
FINAL PRICING AND SAVINGS:
I was actually able to pay the insurance negotiated pricing for the surgeon and the cash pricing for the anesthesiologist and the facility. My final pricing was $1830.34 for the entire procedure. And there lies the proof in the pudding:
Almost $1200 in Savings
Happy Healthy Kid at Great Cost Savings by Paying Cash
Ann Riggs, DO
My patients often prove to be my best resource in providing patient-driven affordable healthcare. A viable health coverage plan eludes many of us and often those with a plan quickly discover its shortcomings. One of our earliest members at Direct Medical Care introduced me to a great alternative to healthcare “insurance”–health cost sharing plans that are truly affordable. These plans have been around for over 20 years and I anticipate they will become more and more favorable with the current direction of healthcare.
Health Cost Sharing Plans
- Health Cost Sharing Plans(HCSP) do qualify as approved health insurance coverage by the Affordable Care Act.
- The general philosophy is in line with Direct Medical Care’s as HCSPs “seek to return health care to a private, patient-centered model” and “(are) designed to restore and protect the doctor-patient relationship.”
- Our patients using these plans attest that their experiences have exceeded their expectations.
Check out the following cost sharing plans:
Samaritan Ministries was established in 1994. Their focus is Christians helping Christians. Not only are they focused on the financial burdens taken on by the community of Christians but the physical, emotional, and spiritual burdens as well.
Christian Care Ministries was established in 1993. Their focus is on carrying each other’s burdens while utilizing not only financial resources but individual talents, networks, and their faith.
Liberty Direct was also established over 20 years ago and interestingly has the same share amounts today that they did when they began. They focus on helping like-minded individuals who are committed to their individual health and well being of their community.
Ann Riggs, DO