As you may know, the doctors started down the DPC path and opened the clinic to get away from the headaches of insurance and the current healthcare system. We are able to offer such heavily discounted prices to our patient because we have eliminated the need for a billing department, etc. by choosing to circumvent insurance (and any other 3rd party payer), and have worked hard to negotiate great cash pricing for our patients for labs, imaging, etc. so that prices are manageable regardless of insurance or third party reimbursement.
As a DPC clinic, we do not make money on these services. In order to play the insurance game, we would need to hire additional staff (billers, coders, secretaries to deal with the extra paperwork/mailing/phone calls, etc.) and would have to charge at least 10 times what we charge for labs now. We believe insurance is there to help cover the cost of expensive, unexpected medical needs. They should not (in our opinion) be meddling in the routine primary care that we provide. We completely understand that healthcare costs/insurance/coverage issues are maddening and that we do things much differently than what most folks are used to.
As a result, we do not use coding or itemized billing systems for our clinic services.
For labs, this means:
For imaging, this means:
For medications, this means:
Ultimately, at the end of the day, we feel that patients have the choice between:
A.) Doctors who provide affordable, accessible care that you pay for yourself - OR -
B.) Doctors who provide expensive, inaccessible care that you get partially (maybe) paid for by someone else.
Clearly, we opted for Option A!
As a DPC clinic, we do not make money on these services. In order to play the insurance game, we would need to hire additional staff (billers, coders, secretaries to deal with the extra paperwork/mailing/phone calls, etc.) and would have to charge at least 10 times what we charge for labs now. We believe insurance is there to help cover the cost of expensive, unexpected medical needs. They should not (in our opinion) be meddling in the routine primary care that we provide. We completely understand that healthcare costs/insurance/coverage issues are maddening and that we do things much differently than what most folks are used to.
As a result, we do not use coding or itemized billing systems for our clinic services.
For labs, this means:
- All labs are billed directly to the patient at the time they are ordered.
- All billing items are included in your monthly itemized receipt, but we do not provide billing codes (see below).
- Our lab prices are significantly cheaper than what lab companies offer via their "direct pricing" as well as what insurance companies deem as "reasonable charges".
For imaging, this means:
- All imaging orders are sent to local imaging facilities (usually Element Medical Imaging or Diagnostic Imaging).
- Our pricing is significantly cheaper than what is usually billed to insurance companies.
- The imaging facility can submit charges to your insurance company, BUT paying our cash rates is often much cheaper out of pocket.
- Example: Cash pay knee MRI = $300. Done, no paperwork, no headaches.
- Insurance submitted knee MRI = $3200.
- Patient has not met deductible, so is charged $3200, OR
- Patient has met deductibe, but still owes 20% coinsurance, so pays $640
- Insurance submitted knee MRI = $3200.
- Example: Cash pay knee MRI = $300. Done, no paperwork, no headaches.
For medications, this means:
- Medications may be filled at our in-house pharmacy at our discounted cost OR prescriptions can be sent to the pharmacy of your choice.
- Prescriptions sent to the pharmacy can be billed to insurance by the pharmacy OR you may pay cash.
- GoodRx is a good resource to find discount coupons for many medications.
- We encourage our patients to shop around!
Ultimately, at the end of the day, we feel that patients have the choice between:
A.) Doctors who provide affordable, accessible care that you pay for yourself - OR -
B.) Doctors who provide expensive, inaccessible care that you get partially (maybe) paid for by someone else.
Clearly, we opted for Option A!
