Recently, I had a discussion with a prospective member about how our Direct Primary Care membership model will fit with his family’s health insurance plan. They had a high deductible plan that covered some preventive services at no cost, but not much else before spending $5000 per person per year. Being in the financial industry, he was shrewd in analyzing the “extra” cost of maintaining a membership with us -- versus using his insurance plan rates while paying out-of-pocket for routine care.
The family was relatively healthy, but Dad had high cholesterol and blood pressure that required a few doctor visits and routine labs per year. Mom recently required a plethora of lab tests for what turned out to be lactose intolerance. Little Johnny broke his leg last year that resulted in an ER trip and cast for 6 weeks.
This care totaled up to $9500 in out-of-pocket expenses over the past 2 years.
After the inquisition, he was quite stunned at the wide disparity in pricing between our fees and his insurance plan “discounts” prices. He encouraged me to create a comparison table to share with prospective members on high deductible insurance.
I took his advice. The table below shows the "typical fee that providers in your area accept as payment from insurance companies" (from a nifty tool at HealthCareBlueBook.com) versus our members price (if any) for the same service. (NOTE: insurance rates can vary widely for a given service and provider, if you can find the information at all!)
Many insured people want to use their health insurance for all care so they can "maximize" it's worth; to "get more out of it". I never get warm fuzzies when holding my plastic health insurance card, but I get it.
However, at these "discount" prices, I'd argue it's more abuse than maximizing value.
The cost for us to provide the families health care over the past two years (including membership fees and non-covered fees) would have totaled $2380. He didn't see our membership fees as "extra" any longer. And next year, with our wholesale medication program, we will be able to save Dad $60 per month ($720/year) on his three medicines.
Maybe Direct Primary Care's best value is as insurance against being further abused by your insurance plan?