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Transparency and Access: How Direct Primary Care Saves You Money

transparency of Direct Primary Care

Somewhere along the line, we began thinking that all of our healthcare had to be covered by insurance – quick visits with your doctor, preventative care, routine medications, and the like. Overnight, health insurance became thought of as a necessary means to access healthcare.  

Take a pause and just consider your options for quality primary care that not only increase access to, and time, with your doctor, but also can provide substantial cost savings for you, the patient. 

Direct Primary Care (DPC), which allows you to have a direct relationship with your doctor, is an option. For the equivalent of (or even less than) your monthly cell phone bill, you can receive direct primary health care services,  from your annual exam to stitching up your child’s finger, and everything in between, all customized to your individual needs. 

Transparency

With DPC, due to the transparent and simplified cost structure and accessibility, we can tell you the costs for all primary care health services up front. There are no surprises, but rather a set cost for labs, procedures, etc.  For example routine labs (blood sugar, CBC, metabolic profile, some thyroid) could run $5-10 per test, and that alone is a huge cost savings when you look at the hundreds of dollars in deductibles paid through insurance. 

It can be difficult to understand the cost breakdown of insurance or healthcare through insurance. After all, you have premiums, co-pays, deductibles, co-insurance, and then add in the thousands of dollars to your cost for your health insurance over a year.

A helpful exercise to gauge the potential cost savings and to see if DPC is right for you and/or your family is to consider how it measures up to a conventional high deductible insurance plan. 

You can do this dollar for dollar to look at your total out of pocket expenses for a typical primary care visit.

  • In addition ask yourself the following questions:
  • How much do I have to pay in your deductible  before primary care is covered?
  • If so, what are my co-pays? 
  • What labs are covered?
  • What is the out of pocket cost if I need to go to urgent care? 

 

 

 

SERVICE

CONVENTIONAL HIGH DEDUCTIBLE PLAN

In network PCP $2,000 deductible per individual $4000 per family

Only preventative visits (physicals and well child checks) are covered by this plan. All other medical visits patient will pay out of pocket until deductible is met and then the services will be covered at 80%.

In this example the 55 year old patient pays $25 a month for the high deductible plan.

TABLE HEALTH PRIMARY MEMBERSHIP (DPC)

  • No deductible to meet
  • No copay
  • ALL MEDICAL VISITS INCLUDED in your monthly fee
  • Select medications and labs also included. 
  • The monthly fee for a 55 year old is $67 per month

Dr. Visit 1  

  • Upper Respiratory yInfection: consult and prescription
  • Cash pay for 15 min. office visit: $138*
  • Z Pack Antibiotic: $8 (Good Rx)
  • 30 min visit: $0
  • Z Pack Antibiotic: $0

Get it in office, no need to go to the pharmacy

  • All included in the monthly membership fee.

Dr. Visit 2  

  • Diagnostic Type 2 Diabetes testing & prescription
  • 15 min office visit: $208
    Labs
  • A1C:  $81
  • Fasting Glucose: $32
  • CBC: $149
  • Medication; Metformin: $15

 

  • Office visit repeated every 3 months: $415
    (follow-up visits are less expensive)
  • Monthly medication: $195
  • Labs every 6 months = $262
  • 45 min. office visit which includes diabetic diet and lifestyle education: $0

Labs

  • A1c Lab: $0
  • Fasting Glucose: $0
  • CBC: $0
  • Medication; Metformin $0 per month
  • All included in monthly membership fee

 

  • 30 min office visit repeated every 3 months
  • Medication monthly
  • Labs every 6 months
  • All included in monthly membership fee

Dr. Visit 3  

  • Cut your finger cooking dinner
  • Your PCP only accepts urgent phone calls on the weekend and is not able to meet you in the office. 

  • Average urgent care visit: $150

  • Average cost of stitches for minor laceration: $150

  • Your DPC physician is on-call for you 24/7. They meet you at the clinic within 30 minutes.
  • 30 min. visit: $0
  • Stitches for minor laceration: $0

Your total out of pocket payment for Primary Care related services:

In one year you paid $300 for your high deductible insurance plan and paid an ADDITIONAL  $1,803 in services not covered by your plan.

In one year you paid $300 for your high deductible plan and $954 for your Direct Primary Care membership, including your sign up fee. This option SAVED you $849 in one years time on medical expenses.

*Average cost for Office or other outpatient visit for the evaluation and management of an established patient, CPT code 99213 is $138, 2018.

Accessibility

Many times, DPC patients are saving money without even realizing it. For example, DPC patients benefit from same day appointments as well as options to access their doctor (even after hours) via phone, Telehealth, or portal, which minimizes trips to more expensive outlets like emergency room, urgent care, and even the specialist office through a referral. This added convenience also allows for less time off of work so you’re not wasting PTO, or seeking childcare coverage, etc. 

All of this is shared to give you more information to consider when deciding if DPC is the right choice for you and your family. A  common misconception is that DPC doesn’t work with insurance. That’s not the case at all. In fact, DPC can work extremely well with or without insurance. Although Table Health does not accept insurance, we do recommend it, but more as a necessity for an emergency or catastrophic care, not primary care.