Like most doctors, Chris Winter, a neurologist and sleep specialist, accepted health insurance at his clinic in Charlottesville, Virginia. But for a decade, he contemplated a change. His expenses are increasing, and as he sees it, the only way he can get more paid under insurance is to see more patients, spending less time on each one.
So, starting this year, Winter stopped taking insurance and started paying patients directly. Winter says it saved him “an unbelievable amount of time in our clinic. “Payment, fight insurance.”
Winter is not alone in deciding to drop insurance. Many mental health therapists do not accept insurance, and among primary care physicians, there is a growing movement in favor of “direct care” models.
Winter said the decision has allowed him to focus his efforts on actually practicing medicine.
“I’m not saying this is something everyone should do, but it suits us and our practice perfectly,” he said.
Why do doctors drop insurance?
The US healthcare system is the most expensive in the world [1] but its people are not the healthiest. Even among Americans with health insurance, 41% avoided medical care because they knew or feared insurance wouldn’t cover the costs. Dr. Harry J. Heiman, a professor at the Georgia State University School of Public Health who has practiced family medicine for 20 years, says it’s a situation where neither patient nor provider satisfied.
Because of the way insurance companies reimburse, many doctors feel they are encouraged to “do more,” regardless of whether or not it adds value to their patients.
“A doctor’s remuneration depends a lot on the number of patients they see, the number of procedures they do, the number of tests they do,” says Heiman.
Therefore, it makes sense that more doctors have been looking for systems where patients pay them directly, where they have a guaranteed income and where they can spend more time with each patient, he said.
Winter had some layers of insulation before diving into direct care. He has many sources of income from consulting for sports teams and the military, from writing books and giving speeches, but his practice costs are so high that he may have to close down if he continues to buy. insurance. Things turned sour earlier in the year when several insurance providers said they would stop paying for his practice “in-network,” which he learned from patients.
Winter took it as a sign it was time to forego the rest of their insurance plans.
How does direct care practice work?
Dr. Josh Umbehr has seen the direct care movement grow since he started medical practice in 2000.
“A lot of times doctors aren’t trying to do anything different or add any value. They just dropped the insurance out of frustration,” he said.
Umbehr launched its direct care clinic, Atlas MD, in Kansas in 2010 and also markets clinic management software to direct care providers under the same name. His clinic charges $10 a month for children and $50, $75 or $100 a month for adults depending on age. The fee buys you unlimited visits, including at your home and office, with no copays.
Because she has control over the number of patients she has, Umbehr is able to communicate more often with her patients, such as asking someone with pink eye to send pictures every hour. Any procedure that can be done in the office is free, from the electrocardiogram to the stitches. The office also distributes drugs directly to patients at a substantial discount.
Umbehr’s company has helped hundreds of doctors join or explore direct care approaches. Ideally, Umbehr says health care should be more like car insurance. With your car, you pay for gas, oil and maintenance, while insurance covers more expensive accidents. The direct care model is not intended to replace hospitals.
Umbehr says many patients use health savings accounts to pay for primary care directly. The IRS didn’t explicitly say this was an approved use of HSA funds, but it didn’t stop it either. On Thursday, US Senators Bill Cassidy, Jeanne Shaheen, Tim Scott and Mark Kelly introduced a bill that would regulate the use of HSAs to pay for direct care. [2] Similar bills have previously stalled in Congress.
A common criticism of such models is that they can leave out patients who cannot afford the usual charges. Winter says he has flexible plans with patients who can’t afford to pay.
“If you talk to any doctor, there’s going to be a lot of people who haven’t paid for them,” says Winter.
Since making the switch, Winter and a nurse see no more than 14 patients a day. He now bills his patients at the time of service, with fees ranging from $120 for follow-ups to $275 for sleep study interpretations.
What can you do if your doctor stops taking insurance?
While Heiman says he doesn’t blame individual providers for taking this step, he says some patients will be left behind if their doctors stop taking out insurance. and they can’t pay the fee. People will still need to purchase health insurance to protect against the costs of a serious accident or illness, so premiums can’t just be transferred to carrier fees.
“All it takes is a serious medical visit or an unplanned emergency and it can literally run into the tens of thousands of dollars,” says Heiman.
For professionals like Winter, the fees he charges can simply replace a copay. But since initial medical visits are usually covered by health insurance, the fees will be an extra cost for everyone.
Switching to direct care can be worthwhile for those who can afford the fees and feel the extra TLC they can get from their doctor is worth it. It can also be helpful to reserve fees in an HSA in advance. But Heiman worries that doctors who take this step may end up limiting themselves to healthier, wealthier patients.
If your doctor decides to switch to the direct care model, Winter recommends talking to them about it.
“Call your doctor,” he said. “Talk to your doctor. This is not an act of malice or belligerence that they may be engaging in or for money. It was probably an act of survival. It can be an action where you are at the center of it.”
