16 July 2019
Hi, thank you for coming back for the latest edition of Beyond Primary Cares blog; where I highlight healthy and fun recipes, healthcare news, advice for medical conditions, as well as how membership for care works! Dr. Jeff O’Boyle is the owner of Beyond Primary Care, which is a new approach to family medicine and addiction medicine that creates the time and space your healthcare deserves. Beyond Primary Care serves patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne County.
The primary purpose of the blog is to introduce healthy lifestyle concepts and answer common questions I receive from patients that I believe are important. I want to start discussions that will help educate, benefit, and improve your well-being.
In this blog post, I will not discuss my personal political views nor will I use this as a medium for healthcare horror stories, like this sad story, this sad story, or this frustrating story… because we have heard these before. In this blog I will discuss facts of what I learned from 1) attending the EMU hosted event for ‘Medicare for All,’ and 2) reading through all the pages available online regarding H.R. 1384.
I recently attended a town hall hosted at Eastern Michigan University (EMU) on Saturday July 13th where Congresswoman Debbie Dingell (Michigan’s 12th District), Congresswoman Primila Jayapal (State of Washington 7th District), State Senator Jeff Irwin (Michigan’s 18th Senate District), State Representative Yousef Rabhi (Michigan’s 53rd District), State Representative Ronnie Peterson (Michigan’s 54th District), as well as Michigan Nurse Association Vice President Katie Scott were all discussing the ‘Medicare for All Act of 2019.’
They were having a discussion about H.R. 1384, the Medicare for All Act of 2019 which is a bill that would establish a national health insurance program to cover all U.S. residents. Currently (as of 7/15/19) the bill has 117 co-sponsors.
To start with the discussion at EMU, I always appreciate an elected officials time (especially on a Saturday night) to discuss what impacts our community. Yes, they did start the panel discussion late, exactly 20 minutes- much like an overfilled physicians waiting room. However, much like those doctors we want to see, we can look past that.
To briefly summarize what they discussed, I felt the panel discussion had an overall vibe of a small group rally for the ‘Medicare for All Act’ with very little substance discussed. To be fair, each speaker only had about 5 minutes. However, 5 minutes should be enough time to pitch something they want to sell. And let’s be honest, our elected officials were trying to sell this bill to the room.
To start with Congresswoman Debbie Dingell’s talk, it was heavy on current healthcare disparity statistics in the US. She did offer some brief talking points such as “We are going to a single billing system that will eliminate a lot of costs.”
The bill claims savings of $500+ billion annually from reductions in costs of billing and administrative costs.
As you can see below of the graph of physicians and administrators from 1970 to 2009, administrative costs are having a major impact on healthcare spending.
I am curious to see how exactly they will implement this administrative cost savings. Does this mean simply cutting back (i.e.- firing) extra staffing? Those are jobs too. Many physician offices utilize administrative staffing such as front desk receptionists, a dedicated phone staff, nurse triage staff, laboratory staff, billing staff, imaging staff, medical record staff, transcription staff, and office management.
Congresswoman Primila Jayapal was next. Seattle, you should be proud, you elected a great official. I would be proud to have her represent me if I were there. I was impressed because I felt she actually covered more substance in her discussion than any of the other speakers regarding the ‘Medicare for All Act.’ She states the act will have four components:
Yay! Some material I can work with. Then congresswoman Jayapal says with these ‘controlled costs’ we will pay 14% less then now. WHAT! 14% ?? So that MRI, instead of being $1,400 is now $200 less? That colonoscopy that is billed at $5,000 is now only $4,300. This cost savings is not significant nor will it move the economic needle of medical costs.
Reading through H.R. 1384, I could honestly find only one section (616): Payments for Prescription Drugs and Approved Devices and Equipment that discussed any effort to reduce healthcare expenditure.
Has she heard of Direct Primary Care (DPC)? Does she know I can get a member an MRI for $300, or a colonoscopy for $700? Direct Primary Care is moving the needle on medical cost economics by saving our patients anywhere from 50-90% off of insurance billed costs.
Michigan State Senator Jeff Irwin spoke next. Again, a good speaker. He discussed how doctors are fighting insurance companies over billing and how much a wasteful system this results in. Senator Irwin did say something I believe is important when discussing healthcare: speaking about what people value in their health and healthcare coverage. But, nothing that added any insight on the actual bill.
State Representative Yousef Rabhi discussed efforts from a Michigan effort to start universal healthcare plan called ‘MiCare.’ In an acknowledgement of supporting information to Representative Rabhi, he did discuss how he plans to fund MiCare through a vote of the people in Michigan for progressive taxation. Yet, to be fair to the audience, I felt his talk was a bit of a curve ball as all other speakers were focused on the federal bill and not the state bill.
State Representative Ronnie Peterson added some personal stories about his history of fighting for racial equality and now fighting for healthcare equality. Again, his talk was touching but added no material onto why or how the ‘Medicare for All Act’ would work.
The last speaker was Katie Scott, the vice-president of the Michigan Nursing Association. From her talk, I was able to pick out that she was an Intensive Care Unit (ICU) nurse. Again with the story telling theme of the night, she gave a personal narrative of high prescription drug costs and how that impacted her.
I absolutely love what nurses do and think their roles are critical towards healthcare. However, ICU nurses and the need they fill are vastly different than what primary care doctors see and what a vast majority of people experience when we think of and utilize healthcare.
If the elected officials pushing for the ‘Medicare for All Act’ want to be serious, they need to get feedback and collaborate with the primary care providers out there already making changes in their communities. Instead of pushing for town halls on why we need change, Direct Primary Doctors are having town halls in communities on how we are already changing healthcare to improve patient access, improve price transparency, and reduce out of pocket costs on everything from office visits, medications, imaging, speciality care, and laboratory studies.
10 May 2019
Hi, thank you for coming back for the latest edition of Beyond Primary Cares blog; where I highlight healthy and fun recipes, healthcare news, advice for medical conditions, as well as how membership for care works! Dr. Jeff O’Boyle is the owner of Beyond Primary Care, which is a new approach to family medicine and addiction medicine that creates the time and space your healthcare deserves. Beyond Primary Care is a Direct Care clinic serving patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne County.
The primary purpose of the blog is to introduce healthy lifestyle concepts and answer common questions I receive from patients that I believe are important. I want to start discussions that will help educate, benefit, and improve your well-being.
In this post I am answering a common question that I receive, and that is how does Beyond Primary Care (DPC) keep laboratory costs low for it’s members? Offering low bill rates for labs is a key feature of virtually all Direct Primary Care (DPC) practices, and is something that is done to increase the value of a membership. Just how low? Many DPC practices do in-clinic phlebotomy and can provide numerous laboratory studies to their patients at a tenth of the costs that many hospitals and fee-for-service providers can provide.
To start DPC practices typically do their own phlebotomy (that is the collection of blood from your veins) and rarely bill for these services. This starts the savings before a single drop of blood is collected. DPC practices then contract with laboratory diagnostic companies, many times the same companies that service smaller hospitals or fee-for-service clinics. My clinic, Beyond Primary Care, uses a few laboratory diagnostic companies, Quest Diagnostics, True Health, and Aurora Diagnostics.
Prior to drawing any labs for our patients, DPC practices negotiate what we call ‘client bill rates’ with these diagnostic companies. A client bill rates is basically saying, what is the lowest cash price for a particular laboratory study you can offer to my clinic’s patients? Compare this to smaller hospitals or fee-for-service providers. They bill for phlebotomy (U of M states they charge $9 for this service alone) and then these providers bill the labs through your insurance. Often times the laboratory costs often never negotiated down on behalf of the patient because there is no incentive from the practice to do this.
DPC gets these low laboratory fees for their members in this innovative manner because our primary business is taking care of you and NOT being just a blood-draw center. Your membership for care to a DPC practice allows for this innovation.
I have a colleague who recently had a pap smear completed, which is a diagnostic test used in females to detect cervical cancer. She claimed she had ‘Cadillac Health Insurance’ through her employer, meaning basically she thought she had really great insurance that would cover the costs of her healthcare. Look at her bill below and what she was left to pay out of pocket. At my clinic, Beyond Primary Care, the procedure of completing the pap smear if part of the membership. No extra charges. The fee for the pathologist (that I have negotiated) is $44. The difference in costs in this ONE laboratory study alone would pay for months of healthcare at any DPC clinic.
DPC providers understand you may need to see another specialist from time to time, and these providers may want their own labs completed. A common question I receive is if the other specialist request labs, can I get them done through your clinic?
Yes, absolutely this is another great way to minimize your financial impact. No doctor or hospital can force any patient to have routine laboratory studies done only at their location or where they tell a patient to complete them at. That is against the law. They may use convincing language saying ‘the results integrate into our electronic system faster,’ or ‘those other providers may not know exactly what I want.’ Stay firm and request a written and signed order for your labs. Your DPC clinic will complete the exact same labs, bill you at the much lower rates (compared had you used your insurance), and will promptly fax the results over to the requesting specialists that meet their needs. As noted by this Wall Street Journal article analysis of medical services, prices tend to be higher when services are performed in hospital outpatient facilitates instead of at doctors’ offices.
19 March 2019
Hi, thank you for reading! My name is Dr. Jeff O’Boyle. I am a board certified family medicine physician. My clinic, Beyond Primary Care is located in Ann Arbor, Michigan. In this post I am answering a common question that I receive, and that is how does Direct Primary Care (DPC) keep medications costs low for it’s members? Offering low priced medications is a key feature of virtually all DPC practices, and is something that is done to increase the value of a membership. Just how low? Many DPC practices do in-clinic dispensing and can provide hundreds of medications to their patients at a tenth of the costs that many national retailers can provide.
DPC practices, like pharmacy retailers have applied for and obtained their medication dispensing license from their respective states. This allows a DPC provider to contract with pharmaceutical wholesalers of medications, the same wholesalers who retail pharmacies such as RiteAid, Walgreens, or CVS may use. My clinic, Beyond Primary Care, uses two wholesalers of medications, AndaMeds and Bonita Pharmaceuticals.
These wholesale companies sell the medications, often in large quantities to the DPC practice. However, unlike hospitals and retail pharmacies where selling medications IS their business – resulting in the expected mark-ups (250%!) and high-prices as noted by the American Journal of Pharmacy Benefits– DPC practices turn around and sell the exact same mediations to their patients at those near-wholesale prices. As noted, DPC sell the medications to their members in this innovative manner because our primary business is taking care of you and NOT being just a pharmacy. Your membership for care to a DPC practice allows for this innovation.
You may be or may know some people who take multiple medications. Medications for blood pressure, diabetes, urinary incontinence, anxiety, heart conditions, COPD, or erectile dysfunction may add up to hundreds of dollars a month you are paying out of your pocket. Compare this to the costs I charge my members for the exact same medications. Often times the money saved in medication costs alone pay for a DPC membership! Don’t see your medication on my sample list? Don’t worry, I may still stock it or I can order it too!
* Prices are subject to change without notice, one month supply listed unless noted
Many DPC practices do in-clinic dispensing of medications. Once the doctor evaluates you and discusses the best course of treatment, that provider can have the necessary medications dispensed to you before you leave the office. In urgent situations, this saves you time, energy, and of course MONEY, something that rarely happens in fee-for-service medical offices.
As I mentioned in my earlier post, there are times a member needs or would benefit from a certain medication that is brand name only (very expensive) and would be best obtained through insurance that requires a prior-authorization (what is prior authorization) from the insurance company.
In this scenario, we will work to fill out the necessary paperwork to get your needed medications at reduced costs or even reach out to the pharmaceutical companies seeking a reimbursement or free supplies on your behalf. A great example is we got one of our members Vivitrol, a vital medication for Medication Assisted Therapy in Addiction Medicine. This medication costs over $1,000 on the market, but we worked to get our member the medication FREE of charge with their insurance. Did I mention the office visit and the injection itself were included with the membership? So the patient literally paid $0. Saving money for our patients gets me so excited!
8 March 2019
Hi, thanks for reading! My name is Dr. Jeff O’Boyle, and I am a board-certified family medicine doctor who owns his own clinic, Beyond Primary Care located in Ann Arbor Michigan. Like most family medicine doctors, our goal is to keep our patients healthy and out of emergency rooms if at all possible. My best friend is an emergency room doctor and I have the utmost respect for the care ER doctors provide and the role they serve in medicine. I have seen people in emergency rooms with life-or-death conditions such as chest pain and shortness of breath, and am grateful we have skilled providers in this area of medicine.
Yet, I meet a good number of people who utilize an emergency room like it’s a one-stop-shop for all their medical health. People going to emergency rooms for dental pain, refills on blood pressure medications, common colds, and various other complaints that have been manifesting themselves over the past 3 months. As a Direct Primary Care (DPC) family medicine clinic, I promote and encourage that longitudinal care with my patients to ask me for medical advise or treatment that can’t be achieved in emergency rooms. Here is some free advice why NOT to go the emergency room.
The trust that develops over time between a doctor and a patient (or family) is absent. It is also extremely helpful to have seen a sick individual or child when they were healthy, to know how far from their baseline they are.
Sick people are not happy people, and it’s hard to do a physical exam on someone stressing out. A familiar face causes less distress, and allows the doctor to do a better evaluation.
The ER team takes care of the sickest patients first. If you have a minor illness and a severely ill or injured person rolls in, you’ll be waiting a while.
This means needle sticks, radiation exposure, and increased cost. Often, a DPC doctor could do a thorough physical exam and schedule a follow-up the next day, all at no additional cost to you. But the ER gets one shot, and they can’t afford to miss something, so they tend to over-order imaging and labs.
They are not tasked with figuring out exactly what is going on and solving every problem; the focus is on ruling out life-threatening conditions and deciding which patients need to be in the hospital. This often frustrates patient’s who come in wanting answers.
In the summer it may be vomiting or diarrhea. In the winter, it’s the flu. Emergency rooms do their best to keep things from spreading, but viruses haven’t survived this long by being bad at what they do. If you weren’t sick when you went in, you may be soon.
This is more altruistic, like vaccinating yourself so nobody else gets the flu–but it’s real. Every ER has a limited number of beds, and when they’re full, they’re full. If they’re full of relatively healthy people, the really sick ones sit in the waiting room until a bed opens up.
This is the most important step, and it’s one that you should take when you are healthy. A good physician can identify diseases early, track a child’s growth and development, provide reassurance when that’s all you need, and handle the vast majority of acute illnesses. If–or rather, when–you get sick, your doctor has access to her records and history, avoiding expensive and unnecessary repeat testing. That doctor will understand your personality and perspectives, and you will be less scared of a familiar face. Look for a Direct Primary Care doctor, who routinely offers same-day sick visits, weekend hours, and phone availability even when the office if closed–a lot of ER visits can be avoided by talking through symptoms over the phone.
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.