14 November 2018
If you are in the process of open-enrollment, consider a better plan- Direct Primary Care (DPC) with Health Insurance. This post is the second of a two-part blog post where I detail how anyone, regardless of their coverage of insurance, would potentially stand to benefit from direct primary care services. Check my earlier blog postings for the first part (and other cool things too… like the recipe for a yummy Chicken Noodle Soup).
You read my first post and have looked at your own insurance or enrollment options, and say “I am paying a lot of money for health insurance.” Maybe you are left wondering how direct primary care can fit in or rather “What kind of health insurance should I purchase with DPC?” I went on a health insurance exchange to give everyone a better idea of what pairing insurance and a membership to Beyond Primary Care would be like.
Practical & Affordable
The following slide features a hypothetical family of four, that lives in Ann Arbor, MI. Let’s say the parents are in their 40s and they have two young children. Their household income is $65,600/year, which is the median. This family has a number of things happen in the course of their hypothetical 2017, listed in the left column. A somewhat busy year medically, but not catastrophic.The family purchases either a gold (high premium, low deductible) plan, a bronze (low premium, high deductible) plan, or a bronze plan paired with Beyond Primary Care ($130 a month for family membership). Then let’s see what each of these occurrences “costs” out-of-pocket under each of the three scenarios, and then add up the total out-of-pocket expenses for 2019 in the last row.
Notice that in the last column, the family paid their bronze plan premium ($10,908 for the year) AND the monthly fee for Beyond Primary Care ($130/month, or $1,560 for the year). Despite the extra expense of Beyond Primary Care, they still came out way ahead compared to the gold and bronze plans. This is because Beyond Primary Care offers many types of out-of-pocket savings, including: no visit copays, no additional fee for stitches, and substantial discounts on labwork, medications, and radiology. These savings help to hedge against using that high deductible.
Tolerance & Values
At some point in your research of health insurance, it no longer becomes analytical but needs to revolve around a conversation about tolerances and values.
What is your risk tolerance? As example, if you pick plan ‘B,’ what monetary hit can your family afford to take if you get ‘run over by the bus?’ Health care in the US, is a service, and it is expensive. What do you value in your healthcare? As example, do you care about longitudinal care? This is where a doctor really knows you and your family. Do you value access to your doctor, or appointments that run on-time?
With Direct Primary Care, patients are paying the practice, so we are very conscious of trying to give a patient their money’s worth. If DPC can give them value (a concept that has become foreign to healthcare) and patients are happy with our care, they will continue to stay in the practice. It’s in DPC’s best interest to do this, so we do a number of things to save patients’ money:
Health Insurance can be Expensive.
Insurance is a hedge against financial disaster, not a prepaid healthcare. DPC is not meant to replace insurance, nor does the model in any way encourage patients to drop their insurance. People need a way to pay for the high-cost areas of care, such as surgery and hospitalizations. DPC doesn’t try to address paying those costs.
Direct Primary care does offer excellent and affordable healthcare that can compliment a person’s insurance. DPC focuses on decreasing their patient’s need for specialty care, ER visits, and hospitalizations by focusing on health and prevention. Doing so can (and does) reduce the need. With Direct Primary care we are delivering a higher level of care at a known price.
7 November 2018
If you are in the process of open-enrollment, consider a better plan- Direct Primary Care (DPC) with Health Insurance. I often get the question, “How does direct primary care work with health insurance?” This post is the first of a two-part blog post where I detail how anyone, regardless of their coverage of insurance our level of income would potentially stand to benefit from direct primary care (DPC) services. Check my blog post regularly for the second part (and other cool things too… like the recipe for a Dorito Taco Salad, because why not?!).
Figure out your Monthly Costs: Known as a Premium
Premiums are what you pay on a monthly basis to be insured. Premiums vary on the type of plan you choose. As example, you’ve done your homework and picked a health plan that costs $150 per month. You are paying $1,800 for essentially an insurance retainer, a cost to keep your insurance active. You’ll need to pay your premium on time every month.
Direct Primary Care has most membership fees are between $50-$100. The pricing for membership fees at my clinic, Beyond Primary Care, can be found here. This gets you full access to your doctor, regardless how many times you need to be seen. You could pay around $600 a year. The cost of a DPC membership is often significantly less than just the cost of having the insurance, let alone using it.
Reaching your Deductible
Deductibles are what you have to pay out of pocket before your health care plan kicks in. You may also have different annual deductibles for different types of care (as example: hospital care, laboratory tests, medications, etc). As example, you pick a plan with a $1,000 deductible meaning you are on the hook for all medical bills up to that amount before insurance kicks in.
Direct Primary Care provides you with with primary care services without government or insurance involvement. Your membership to a DPC practice does not influence your deductible. As example, you see your DPC doctor because of a mysterious symptoms. That visit was covered by your membership. When a person goes to a traditional fee-for-service practice, they won’t know the cost of care upfront, and labs and medications are potentially much more expensive than we offer. The predictability and transparency of cost is what makes DPC appealing.
Understanding the Relationships between Premiums and Deductibles
If you are healthy, you may want to dish out as little money as possible on the monthly premiums (to keep more in your own pocket), but still have coverage in case of an accident, sudden illness, or life change. Be aware, the less you pay for that monthly premium, the higher your annual deductible. Some folks may want a low deductible, but your premium will be thousands of dollars a year.
Direct Primary Care offers these healthier people improved access to care. Just because you are assigned a doctor by your insurance doesn’t actually mean you get to see your doctor, let alone in a timely fashion. DPC does not charge more for complicated patients, or management of difficult or chronic medical conditions that require more frequent trips to see the doctor.
This is a fixed percentage of your medical bill you share with your insurance company once you have reached your deductible. As example, you have a 80/20 plan. This means if you have a doctor visit after you reached your deductible, and their fee is $150, you are on the hook for $30 while your insurance covers the rest. You still have your copayment though.
This feature is just as important as premiums and deductibles, and is a term for the total amount your insurance plan will require you to spend on medical care in a single year. If you reach this amount, your health insurance will cover the rest of your care. Note, you may have reached your deductible, but are below your out-of-pocket maximum, you will still be required to pay some of your health care costs.
Seeking Transparency in Health Care Costs
No wonder health insurance is so frustrating and confusing for most people. Using automobile insurance as a parallel, health insurance has done the equivalent of paying for gas, oil changes, windshield wipers, and other car repairs in addition to covering collision and liability. Using insurance would allow these things to have artificially set prices which are unreasonably high (since it’s covered by insurance). The cost of your routine maintenance would go up, and insurance could dictate what shop or gas station you could go to for service. But in reality, consumers are already motivated to do those things and will pay out of pocket to maintain their car so as to avoid needing to use their auto insurance at all.
Health insurance is suppose to be a hedge against financial disaster, but people are seemingly are using insurance to cover every ache, pain, anxiety, and pill resulting in artificially inflated prices. How can a outpatient clinic charge $600 for 1-hr procedure? Or $90 for a generic medication? Because unlike bananas, Americans and most doctors have NO idea what an one hour procedure or generic medication should cost- and ultimately how much they will be on the hook for- until they decide to get it done. For better or worse, this has created a demand for transparency among individuals. Direct Primary Care can help fill that void. Check back soon for part 2 of this blog post.
25 October 2018
The picture is a plastic suction bulb, or ‘booger sucker’ as newborn parents like to say. You can find these in most stores, typically in the newborn section for $1-2. Why am I posting about this you ask? Suction bulbs allow us to do nasal rinses. The traditional method has been the net pot, but I prefer the suction bulb. Nasal rinses are an ancient practice that has been shown to have benefit relieving both allergy and cold symptoms.
Essentially, it involves sending a stream of saline (salt-water) solution up one side of your nose and back out. No, I do not believe it has to go in one nostril and out the other. Gag! The act of bathing the turbinates and sinuses in saline water is all this is required, along with a thorough blowing of the nose afterwards.
You can buy individual packets to mix with water, but because my readers are thrifty- I suspect they want to make their own. To make your own:
Yes, what comes out is disgusting and you may get a salty taste in your mouth, but you will feel better. I typically advise people to rinse x4-8 per day. The bottom line is the more you do this, the better you will feel- quicker.
23 October 2018
At Beyond Primary Care, we have a narrow focus- you and your family. Dr. O’Boyle is a dually board certified Family Medicine Doctor, and sees children of all ages, whether that is for the urgent needs, school physicals, check-ups, or that mysterious illness that you have questions about.
One of Dr. O’Boyle’s biggest annoyances of traditional physician offices are their limited hours and seemingly robotic answers from the on-call services. Does your child only get sick between 9 AM and 5 PM, Monday through Friday? If they do get sick during this time period, you have endless ability to take off time from your work (usually a half-day or more) to be seen at the office? Experience the on-call doctor reading the hospital script that if your child is sick you should take them to an urgent care or emergency room? Then the wait time at these locations!
At Beyond Primary Care, we will work with you to make time for convenient appointments, whether you need to be seen traditional working times or after-hours. Additionally, we because we know you so well, we offer our patients ‘virtual home visits,’ or ‘tele-medicine.’ Many illnesses can be diagnosed and treated with a simple conversation by phone or webcam. There is no corporate legalese with Dr. O’Boyle. When you enroll and call, you speak directly to Dr. O’Boyle and will get unabridged advice and care.
What are the benefits of having your family enroll in a direct primary care practice? According to this newspaper, DPC patients are 52 percent less likely to require hospitalization than patients under a traditional model. By providing the vast majority of care needed at the primary care level, a DPC doctor can allow a person to purchase the bare minimum insurance policy that is right for their family. The savings with this alone can be thousands of dollars each year.
22 October 2018
Hello and thank you reading my blog at Beyond Primary Care and trying the BPC Good Eats recipes. This featured recipe is a Apple Harvest Salad. These recipes are my attempt, in a way, to bridge that Doctor’s adage of “Eat Better & Exercise More.” In this post, I will showcase a healthy meal made on a budget, my pictures are pretty decent, and that is how I got into this food endeavor.
Apple Harvest Salad
Adapted from: The Seasoned Mom
Prep Time: 15 minutes
Total Time: 15 minutes
Ingredients for Cider Vinaigrette Dressing
3 tablespoons extra-virgin olive oil
3 tablespoons apple cider vinegar
1 teaspoon onion powder
4 teaspoons Dijon mustard
4 teaspoons maple syrup
½ teaspoon salt
¼ teaspoon pepper
Ingredients for Apple Harvest Salad
4 cups spring mix (or other greens of choice)
2 apples (a variety you would enjoy), diced
Juice from ½ of a lemon
1 cup dried cranberries
4 ounces crumbled blue cheese
1 cup pecans, coarsely chopped and toasted
1) Whisk together dressing ingredients in a small bowl or measuring cup until completely combined, set aside or divide into smaller containers for individual lunches.
2) Place diced apple in a small bowl and squeeze lemon over the bowl. Toss apple in lemon juice to coat (this will prevent browning).
3) Divide salad ingredients among the containers, layering in the following: greens, apples, cranberries, and cheese.
4) When ready to serve, empty the dressing containers onto the salad, top with pecans, and toss to coat.
16 October 2018
Did I mention that at Beyond Primary Care in Ann Arbor Michigan, we aim to bring affordable blood work to you by being 100% transparent about our pricing? I have mentioned this before about individual medications, but after all, there is more than just medications to be transparent about.
Can you remember an instance where a doctor advised you to get blood work done, but they didn’t know if your insurance would cover it or even how much it would cost? There are examples of this occurring all the time in the news. Such as a $17,000 bill for a urine drug screen or owing $478 dollars for a complete blood count and comprehensive metabolic panel (Our shameless self-promoting plug, Beyond Primary Care’s total price for these tests is $17.28). As a personal example, my wife recently got blood work for what the doctors described as a nominal cost. Yet, the explanation of benefits we received stated the insurance would not cover the tests, which are priced at 4-figures! Upon discovering this and discussing with both the insurance and the doctor’s office, no one has yet to give us reassurances or answers. No transparency there.
The jury is still out on my personal experience, but you can avoid the headaches and uncertainty of this type of disjointed healthcare. At Beyond Primary Care, if lab work is needed, Dr. O’Boyle will discuss with you the reason for the blood work and discuss the total costs of the blood work before beginning. Dr. O’Boyle performs his own blood draws (naturally at no additional cost to you), and then finally sends them out to be interpreted at those agreed upon reduced costs.
What about those affordable blood work results? Dr. O’Boyle will communicate with you what the laboratory study means, perhaps in office, through a phone call, or a text- just to give you peace of mind. That is comprehensive family medicine.
10 October 2018
Did Beyond Primary Care mention that we have an in-house medication dispensary that saves money to our patients? Check out the pricing comparison of a common antibiotic, Penicillin, that is used for many ailments such as strep throat. Don’t worry if you have a penicillin allergy, we have affordable alternatives also! This can save our patients hundreds, if not thousands of dollars a year. How you may ask?
We buy medications wholesale. We then have our drug control license, that many traditional doctor offices refuse to get either due to contractual or logistic limitations. Another advantage of enrolling with a Direct Primary Care doctor. We then of course pass the savings on to you!
If you want to think differently about health care come join us! Not only are we personable, we work hard to save our patient’s $$$$.
9 October 2018
At Beyond Primary Care, we hear this story a lot: “I am insured but am worried about rising health care costs.” Employees are paying more for health insurance face serious concerns about how they will pay their medical bills in the event they actually need care. For example, more and more people are enrolled in plans with high deductibles. In 2010, one in 10 workers with single-person health insurance coverage had a plan that required a deductible of $2,000 or more. By 2018, one in four did.
Traditional doctor’s offices, where charges are often opaque and disclosed only after services are rendered, leave many people apprehensive about actually using their insurance. In an August 2018 survey, 37 percent of people with employer coverage said they have received a bill for health care costs that they were NOT expecting. Either because they thought their insurance would cover it, or the insurer would foot a larger part of the bill.
Patient’s preferences- for convenience, fast but thorough service, connectivity and price transparency- are making many adults with employer-sponsored insurance turn towards a constellation of alternative services as they face rising costs. Healthy employees still need coordinated and longitudinal care, someone who knows them. A recent report in JAMA Internal Medicine found that nearly half of patients who sought treatment at an urgent care clinic for a cold, the flu, or similar respiratory ailment left with an unnecessary and potentially harmful prescription for antibiotics.
It doesn’t have to be this way. With an employer sponsored membership at Beyond Primary Care, our goal is to maximize employee health and minimize costs. Please contact us today or make an appointment to learn more about Beyond Primary Care.
3 October 2018
In this video I am answering a common question that I receive, so much so that I have added it to my FAQ page, and that is what are the differences between Direct Primary Care medicine and Concierge Medicine? A lot of people may unknowingly alternate between these terms, but these terms are not synonymous.
Direct Primary Care’s goal is to return as much value to our patients in exchange for the membership by being transparent about the true costs of services. Think Southwest Airlines,” as way of comparison. Southwest provides air travel accessible to everyone with a whole different vibe.” With Direct Primary Care, and specifically Beyond Primary Care in Ann Arbor, practices aren’t “changing the medicine, but changing the way we consume it.”
2 October 2018
Hi and thank you for your interest in Direct Primary Care (DPC). Our clinic, Beyond Primary Care, is part of a doctor movement to improve access to our patients. Patients get more personalized care. Patients may also save money on insurance if they can pair their direct primary care membership with a cheaper, high-deductible policy.
The main reason many people cannot afford health care is because it’s too dang expensive. Most patients will seek DPC because they could not afford insurance premiums and/or out-of-pocket expenses under the current system. Watch me explain more about Direct Primary Care and how patients can save money.
Direct Primary Care is NOT insurance. In fact, we recommend all our patients have some type of insurance as accidents may happen. Insurance is absolutely necessary for certain types of care. Some events and conditions are inherently expensive. However, hypertension management and radiation treatment for brain cancer are radically different things. Why should we pay for them in the exact same manner? With Beyond Primary Care, I am delivering a higher level of care at a known price. If you can not afford insurance, direct primary care is an affordable healthcare option.