Medical Care in 2022: Cash Pay vs. Insurance, Why Am I Confused?
Sometimes things do not make sense in life.
OK, let’s be honest, MANY things do NOT make sense in life.
But the “show must go on” right?!? Yes, we must muddle through it all and forge ahead, making the best choices daily with the knowledge that we have at the time.
At the Healthy Human, we talk about these difficult topics daily. We try to make sense of healthcare with our patients. ONE Patient at a Time. We equip them with the knowledge that we have. We offer medical options that are not only affordable, but are transparent. And the result, a patient that can make a choice to treat diseases, to push forward with grit and determination to navigate towards a "life well-lived."
When you take the time to educate a patient about their health, and what they can do to make significant changes, you get a phenomenal result ...a "Healthier, Happier HUMAN.”
We have grown up in the mindset of how "health insurance is supposed to work.” We think using it always saves us money, partly because we assume our insurer negotiates the best rates for health services, and partly because we expect our insurer to pick up the tab for whatever cost remains, or at least much of it. But this is not always true. Unfortunately.
For individuals with high-deductible plans, they must spend thousands of dollars on health services before insurance even starts to kick in to cover some of the cost. We find that patients are happier with not only their money savings per year at the Direct Primary Care (DPC), but also the healthcare home itself.
"Just walking through the doors is a JOY," one of our patients posted on Facebook this week.
Our medical team consists of highly trained professionals with a strong PASSION for helping humans, and our patients benefit from their care daily (and the lower costs).
According to experts at Consumer Reports, patients who pay cash upfront and forgo using their insurance, will receive big discounts for their services. Cash based care is cutting out the insurer as the middleman and it can significantly reduce the patients healthcare costs, and help your medical team as well. With the Physician and medical team working for the “patient” and not the insurance company, we are able to make the focus on YOU and not the paperwork, algorithms, and “red tape” of insurance companies.
Am I proposing you should not have health insurance or carry some sort of coverage? No, I am not.
And I am not an insurance or financial advisor. Like homeowner and auto insurance, health insurance protects you from financial shocks that could bankrupt you if you, or a family member, has a medical crisis that requires major hospitalization or expensive treatments.
At the HH, it is important to follow our medical oath, “at first do no harm.” However, we find it EQUALLY important to also abide by this on a financial front as well, “at first do no medical AND financial harm.” We believe you must care for the patient from a medical and financial aspect, as this is important in mental and physical health as well.
Too good to be true?? What are the drawbacks?
The main one: The money you spend on cash pay services typically won’t count toward your deductible.
However, at any time you desire to use your insurance for “meeting your deductible” or if you desire to use it from the get-go, we do allow this on everything except your medical visits with your Physician/Provider. If you are in a health sharing community, most will allow you to sign a form that allows a percentage/set amount to be refunded monthly.
If you have an HSA/FSA, you are able to use this for set costs such as procedures, medications, imaging, and more at the DPC. Instances where an HSA Patient has used medical services at the HH DPC, or other Healthy Human locations, is typically in the setting of a one time visit or consultation of specialty services such as Allergy, Autoimmune and/or Thyroid, Male & Female Hormone Consultations, etc. They will also use their HSA for Dermatology Consults & procedures, Obstetrics and more.
At the end of the day, REMEMBER paying directly, rather than using your insurance, may OR may not be the right move for you. Weigh the situation for you and your family, only YOU can determine if this type of healthcare meets your specific circumstances.
To start, consider checking your insurance company's website, or call your insurer, to get an estimate of the cost of your tests or procedures. When you do this, don’t forget to consider or calculate things like copays and coinsurance, which require you to pay a percentage of the cost of a service (typically 20 percent).
At the Healthy Human we have made our pricing affordable in all aspects of Primary Care, including outpatient procedures such as, but not limited to, endometrial ablations. We have worked with our specialists and contracted cash pay rates for imaging, surgeries, and more IF you desire cash pay rates.
A Primary Care Membership, covering medical visits for an Adult, for one year of healthcare at the HH is $780-1188 depending upon your age tier and your Physician/Provider. This may OR may not be a lot of money to some, but for a family with a high deductible—say $8,300, the average for families who buy insurance on their own—paying cash could help them save thousands.
And you cannot beat the pricing for an HH Child/Adolescent Primary Care Membership! You are looking at $348 for an Annual Membership, which covers the costs of your Physician/Provider calls for after clinic hour needs, medical visits for the year, and well-child checks. Wouldn’t it be nice to have the security of the same medical team helping answer questions about your child instead of using random Providers in an urgent care or walk in clinic when an urgent need should arise? Seeing the same medical team, having complete medical records on a patient, and building a long term relationship with your Physician/Provider, and their team, is a desirable aspect of medical care. It helps to create an environment for life-long health early in life, and brings back the unique/vintage medical home of the old days with your local General Practitioner.
For Members are Obstetric Packages, are $900 for a 9-month OB Membership/Vaginal Delivery, $1350 for a 9-month OB Membership/Cesarean Delivery.
Non-Member Obstetric Packages range from $1485 for a 9-month ($165/mo) Non-Member Membership Vaginal Delivery, $1935 for a 9-month ($215/mo) Non-Member Membership Cesarean Delivery.
We will begin Aesthetic Memberships in Spring 2022, this will include Botox/Filler Memberships and MORE.
With the chaos of the pandemic world, at the Healthy Human we find comfort and joy in our cash pay medical model, offering Direct Primary Care, Women’s & Mean’s Health, Obstetrics, Aesthetics, & MORE, to those locally and across Nebraska. The DPC will continue to serve!
For those that have trusted us with their healthcare, and those that will continue to come through our doors, we cannot thank you enough for your continued faith in our mission, as well as our HH Medical Team.
And for those looking for a "healthcare change"....you can call to have questions answered by our HH Medical Team and/or our Receptionist, or you can push past your "cash pay fears" and dive right in by enrolling online at: https://thehealthyhumandirectprimarycare.atlas.md/enrollment/index.html?account=hdNX17Z1Sgts4rQK5LVu.
My Best in Health & Wellness,
Amber Beckenhauer, DO
Proud Nebraska Family Physician & Owner of the Healthy Human locations
HHDPC Ashland & Blair, as well as HHMedAesthetics & Market