Transparency and Access: How Direct Primary Care Saves You Money

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.  

If you’re wondering why “covered” is in quotation marks, it’s because “covered” doesn’t necessarily mean “paid for”.  Most people don’t meet their deductible each year, so they usually pay quite a bit (sometimes all) of their medical bills, especially for primary care.  Common examples are visits and testing  for acute and chronic  illness like respiratory infections and medication checks.  Although these are technically “covered” by insurance, according to insurance-speak, most people pay the full amount in two payments (copay and balance bill) because they haven’t yet met their deductible.  

Instead of assuming having insurance is less expensive, take a pause and consider your options for high quality primary care that not only increases access to your doctor, but also can provide substantial cost savings for you, the patient, even if your employer pays your insurance premium.

Direct Primary Care (DPC), which allows you to have a direct financial relationship with your doctor, is an option. For the equivalent of (or even less than) your monthly cell phone bill, you can receive comprehensive direct primary health care services and testing,  from your annual exam to stitching up your child’s finger, and everything in between, all done less expensively because the middlemen aren’t there.  It’s a more traditional approach to the patient-doctor relationship – think old fashioned general practitioner who knows you well,  isn’t too busy, and isn’t expensive – a model that embraces the simplicity of an affordable,  transparent direct payment, before all the complexity came along.

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

It can be difficult to understand the cost breakdown of healthcare through insurance. Even if your employer pays your whole premium, you still have co-pays, deductibles, and co-insurance that are coming out of your pocket.  Most people assume it’s less expensive to have insurance for primary care, but that’s not necessarily true.  Even if you see your doctor only  a few times a year, you’re probably paying more out of pocket with insurance than you would be with a DPC membership.

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.

Click below to view a side-by-side service and cost comparison for a “Dawn” a 55 year old patient with a Conventional High Deductible Plan compared to a Table Health Primary Membership (DPC) services.

In network PCP $2,000 deductible per individual $4000 per family
Only preventative visits (annual 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.