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WHAT SHALL WE DO WITH A PIRATE’S PLUNDER
PIRATE FINANCE 301
AN ALTERNATIVE APPROACH TO PRIMARY MEDICAL CARE
By Kraven Moregrog
Since arriving on the healthcare scene in the mid-2000s, Direct Primary Care has grown in popularity. As health insurance gets increasingly confusing, expensive, and frustrating, new models of care are rising. Patients without health insurance, or those fed up with paying skyrocketing monthly premiums, are turning to Direct Primary Care as an option to afford basic medical care.
Direct Primary Care is a financial arrangement made directly between a patient and a healthcare provider. It cuts the insurance providers out of the process, erasing the need for patients and providers alike to file health insurance claims. Instead, they pay their healthcare provider a monthly fee. e monthly fee covers all—or most—typical primary care services. is includes preventative care and laboratory tests like blood tests or urinalysis, care coordination (medication check-ups), comprehensive care (visits for strep throat or the flu), and consultations. In most of these monthly financial “Pirate's Plunder” columns, we draw a parallel between the golden age of Piracy and the modern equivalent…which, in this case might be the Ship's Surgeon and/or Carpenter who o en doubled as surgeons, sawing off limbs that were wounded in ba le.…but in truth would be much closer parallel with the old fashioned FAMILY DOCTOR of the 1960's and 1970's who took care of everything short of a hospital stay.
There are several aspects of Direct Primary Care to consider before entering into a financial agreement with a healthcare provider. Here are some of the Pros and Cons of Direct Primary Care.
Pro: More time directly with your doctor.
Direct Primary Care physicians and their staff are able to avoid the time normally spent preparing and filing insurance claim paperwork. is allows for more and longer in-depth visits and consultations with their patients. Direct Primary Care practices also typically have fewer overall patients than those accepting insurance.
Providers are able to get to know their patients' health history and story in detail, creating an opportunity for more personalized care.
Pro: Accessibility and convenience
Direct Primary Care patients usually have access to same-day and next-day visits, 30 to 60-minute appointments, and the option to call, email, text, or video chat with a provider 24/7. Some practices even boast of doing house calls. In traditional health insurance plans, many doctors do not provide this much accessibility because it's impossible to bill insurance companies for phone or video visits.
Pro: Upfront pricing
Direct Primary Care simplifies medical billing considerably. Patients know the exact monthly cost of membership as well as the flat fee (if any) for contracted outside services, like lab fees. is monthly membership fee does not vary based on the services provided…or for multiple visits. With a traditional health insurance plan, a patient leaves the doctor's office without knowledge of exactly what—OR HOW MUCH—their insurance will be billed and/or what will be approved and covered. ere is very li le transparency and you don't know what your visit cost until a er deductibles or copays are applied and discounts are negotiated between the provider and insurance company, the patient receives a BILL as an explanation of what they are expected to pay for the visit.
Pro: Low Cost for Direct Primary Care
The monthly fee for most Direct Primary Care services is determined based on a patient's age, the type of practice, and the number of individual family members on the plan. at fee gives patients unlimited and direct access to their primary care provider and covers the primary care consultations. Accepted forms of payment vary by provider. In most instances, options like card, cash, or checks are accepted.
Con: You'll probably still need insurance coverage
Visits to specialists, urgent care, or the hospital are not included in the monthly fee. Prescriptions are also not usually part of a Direct Primary Care financial agreement with a doctor. at's why you'll probably need to pair your Direct Primary Care membership with some sort of insurance plan. Many Direct Primary Care patients also have a high deductible health plan.
Patients on Medicare or Medicaid may use Direct Primary Care providers. However, they will have to sign an agreement stating that any and all services provided will not be billed to Medicare or Medicaid. Although Direct Primary Care may cost less than traditional health insurance monthly premiums, the lack of coverage for other potentially high dollar healthrelated expenses may leave you financially vulnerable…unless the patient also has a high deductible health plan (HDHP). Direct Primary Care providers do not offer services like surgeries, treat complex or catastrophic health issues like cancer, or handle emergencies like a heart a ack. Direct Primary Care also does not cover hospitalization charges or treatment received in the emergency room or at an urgent care facility. A HDHP is one way to prevent financial devastation in the event you require emergency, serious, or extensive care.
Con: Membership does NOT count toward a deductible.
The IRS currently categorizes Direct Primary Care and its monthly membership fee as a “health plan.” So, the monthly cost is not eligible to go toward a deductible if you also carry high deductible health insurance coverage.
Is Direct Primary Care for me?
The modern movement towards direct primary care integrates the advances of medical science with the qualities that made the old-fashioned family doctor so beloved. is hybrid approach is ideal for many different groups of people, including:
• Patients with lower cost, large deductible insurance policies (catastrophic plans), as these products typically do not pay for outpatient visits.
• Patients with complex medical histories typically requiring frequent medical visits and needing more time with their provider.
• Patients who want to take charge of their own health care, without government or insurance interference.
• Patients who make too much income to qualify for Affordable Care Act (ACA) subsidies.
• Patients who are self-employed, and those who receive li le or no insurance from their employer.
• Patients who are between jobs and have no insurance coverage, or those whose insurance coverage has been cancelled.
Busy working professionals, cra vendors, small business owners and their employees as well as active families find the convenience, affordability and accessibility to their doctor a ractive in their daily lives. Once they discover the benefits of Direct Primary Care, they rarely go back to the traditional model.
However, because Direct Primary Care memberships are usually paired with HDHPs, they might not be the best choice for people who need specialized care or who have complex medical issues. Direct Primary Care may be best for patients who are generally healthy and need to see a primary care physician for routine visits or short-term health issues. If you're interested in this type of program and you do not currently have a primary care provider,
The Direct Primary Care Coali on
DPC Fron er Mapper
are two resources to help you locate a Direct Primary Care practice in your area. Currently, there are over
1,000 prac ces
participating in Direct Primary Care in 48 states plus Washington D.C. And experts expect those numbers to continue to grow.
The bottom line, As with any health insurance plan, it's best to weigh all the pros and cons based on your individual needs before entering into any agreement. Be sure to ask your primary care provider about any exclusions, restrictions or limitations, and requirements of their specific Direct Primary Care plan before making any changes to your health care coverage.
The Scarlett Rose
PIRATE NATION MAGAZINE