Absolutely. We do not work for insurance in our office, but you may use your insurance for anything that it would normally cover outside of our office. For example, if you need an MRI, we can submit that referral with the diagnosis codes needed for insurance purposes. If you don’t have insurance or you have a health sharing ministry or a high deductible, we can help determine the direct pay price for services outside of our office. In many cases, even if you have insurance, you can save money by paying directly at the time of service rather than paying the higher insurance negotiated rates. This is a good option if you believe that you won’t reach your deductible.
No, in Concierge Medicine (MDVIP for example) you pay two ways. Concierge members pay cash for access and then you are still are billed through insurance for the medical care. The access fee enables the doctor to see fewer patients and gives the patients more access to their doctor, but the doctors are still working for and contracted with insurance, the government and, often, a concierge management company.
In direct primary care, the doctor is paid by and works for their patient. Your doctor works only for you and your payments to him include the medical care.
Direct Primary Care compared to Concierge Medicine
Average prices according to an American Association of Family Physicians – see article link below.
Direct Primary Care doctors do not accept payment from any insurance company or the government. Your insurance coverage remains effective for specialist visits, hospitalization or other costs that are normally covered under your insurance. Being referred by a direct primary care doctor does not diminish in any way the validity of your insurance.
If you want to read more about the differences, here is an article that you may find helpful: Direct Primary Care vs. Concierge Medicine: Which is Right for You?
Dr. Fischer and Dr. Lapinskes can take care of any patient regardless of your insurance situation. They work completely outside of the insurance system and therefore none of the billing for care here is eligible for insurance reimbursement. Membership fees are not reimbursable by insurance and we do not code for office visits because we do not want to be influenced or directed in any way by the coding requirements of insurance. Coding is simply a payment system for insurance and government payers and it not only does not have any clinical benefit, but it can be a distraction from your health care.
We recommend that everyone has insurance coverage for major health expenses (cancer, accidents, etc). Being a patient here does not negate your insurance benefits in any way, but we have no contracts with insurance providers and will not be paid by insurance at the clinic. The primary reason for this is that we want to have a direct relationship with our patients and minimize the influence of third-party payers on options and therefore our medical decision making. You may save money because we are not bound by insurance contracts to charge a minimum rate and our wholesale prices are often lower than the price your insurance has negotiated with other providers. We do not have to back office overhead that insurance based practices have, so we do not have to inflate prices on things like your EKGs, flu tests and other in-house services.
If we need to send you to a specialists or for testing outside of our office, we will use appropriate medical coding and stay on hold with your insurance company as long as we must to make sure that your insurance is useful when you need it. We want you to be able to use your insurance for those higher priced services when it makes sense. However, we often find that patients get better pricing by requesting discounted pricing for payment at the time of service and we can help provide the transparent price so that you can make the best financial as well as clinical decision.
Simple and Transparent Pricing
You will always know exactly what everything costs and you can make decisions based on posted prices. You will never leave and wonder what mystery charges might not be covered by your insurance. Our members will receive highly discounted pricing for labs and minor procedures because our prices are based on our actual costs, not prices inflated by insurance contracts. For example if you need a CBC your cost is $4. If we had contracts with insurers, we would be legally obligated to charge higher prices.
One of our members accidentally got billed through insurance for their physical labs. The amount billed was $432.00 for our standard labs. Their insurance paid $383.79, Leaving the patient responsible for $48.21 which sounds like their insurance really helped them to save.
However, our real costs for the labs were $25.55.
I would imagine that this member pays more in their monthly insurance premium that they do annually for their Fischer Clinic membership. If you didn’t have transparent pricing information you might think that your insurance company saved your $383.79. Instead, you are paying a premium in order to pay a premium. Because we don’t have insurance contracts, we can legally pass our savings on to you.
Insurance-based doctors spend incredible amounts of time pecking away at the computer in an attempt to satisfy the billing and coding requirements of payers. None of this work benefits patients in any way and keeps them from being able to spend their time in more clinically productive ways such as reading medical journals or researching. You are better served by a doctor whose focus is on clinical medicine rather than on clerical and administrative tasks. In our practice, Dr. Fischer and Dr. Lapinskes are able to be involved and present when you need them, allocating their time and attention in response to your needs rather than having their time taken up meeting the data collection and entry requirements of payers. They would much rather take calls from worried patients every night than to spend evenings doing data entry for insurers and the government. If you need them after hours, please do not hesitate to call. We are here for you!
Under the insurance payment system, most primary care doctors are responsible for over 2000 patients which means that their patients often see other doctors and mid-level providers when they are sick resulting in fragmented care and de-personalized medical care. We plan to only accept as many patients as Dr. Fischer and Dr. Lapinskes can care for in a personalized and timely way. We feel that it is important for your personal doctor to take care of you when you are well and when you are sick in order for him to have a clearer picture of your overall health.
Our minimum appointment time is 30 minutes. You don’t have to stay the whole time if you don’t need to, but you will not be rushed through the visit. The 15 minute office visit and double-booking evolved as a response to economic pressure associated with rising office overhead without commensurate rise in reimbursement, creating the “volume” business that medicine has become. Neither the patient nor the physician thrives in that environment, and certainly the relationship between patient and physician suffers. Our priority is to allow time for the purposes of the patient physician relationship to be fully realized.
As our country attempts to gain control of healthcare costs, primary care doctors are at the epicenter of that effort. Increasingly, primary care doctors are being financially penalized and rewarded for the total health care expenditures incurred by their patients. Dr. Fischer and Dr. Lapinskes feel strongly that their duty is to the well being of their patients and that the misalignment of financial incentives with professional duties puts them an ethically untenable situation.
Also, your health records belong to you and we do not send them anywhere without your permission. Our records are not even sent as “scrubbed” data without personal identifiers. Your health information is never sold.
DPC, The Netflix of Healthcare – This is a blog by a fellow direct primary care doctor, and it includes a link to a talk that we saw at a conference for DPC doctors last year.
At the end of Dr. Gold’s blog on DPC, he links to this incredible lecture by David Goldhill- CEO of the Game Show Network and author of “Catastrophic Care- How the American Healthcare System Killed My Father”- that I was fortunate enough to be present at this October in Dallas. His book is also worth reading. Besides a mortgage, healthcare is the largest personal expenditure that most people have so be informed and learn.
This website can be helpful to see how other doctors are working directly for patients and achieving better results at lower prices. Many patients with high-deductible health plans could save money by flying to Oklahoma for their surgery. In some cases, the Surgery Center of Oklahoma can be even more cost effective than using your insurance and paying your portion.