Background
My 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
research 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 Sick
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)
|
$6918.65 |
|
Comparison(HSA & Direct Medical Care)
|
$1863.45
|
| SAVINGS |
$5055.20
|
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).
● 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.
After 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.
Conclusion
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:
- 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.
- 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.
- I have Obamacare with a high deductible plan already.
- DON’T WAIT! You can’t afford not to join.
Patient-Driven Affordable Healthcare
be inaccurate. Some studies suggest the influenza swab is only 30% accurate while others suggest 70% accuracy. The best case scenario it misses 3 out of 10 individuals with influenza. This makes clinical suspicion and evaluation by your physician key in diagnosis.
limitations. They need to be started within 48-72 hours of onset of symptoms. Antivirals when started early in the course of the illness can decrease the severity of symptoms and length of course but are not a cure. Large families or those with high risk individuals may opt to take antivirals as preventive or prophylactic care when a known influenza carrier has been diagnosed.
The CDC recommends annual vaccination for everyone 6 months of age and older.
Direct Medical Care 