Countdowns are different for different people.
Some are counting down until Christmas…some to the New Year.
Others are counting down the days left to enroll in an individual, or family, insurance plan for 2021.
After struggling through 2020, people all over the United States are ready for what 2021 may bring. For many of us, it may bring relief. However, as with any typical day in our personal lives, it will bring forth difficult decisions…and for most of America, that difficult decision revolves around healthcare. What affordable options do I have in 2021?
We all crave a higher quality of life, which is structured around health and happiness. We all deserve a chance to be, and stay, healthy. This typically is determined by what you can afford and who(m) is in your medical care team to help guide your physical and mental heath. We all want a medical professional that we trust.
So, how do you muddle through these waters as a layperson? It is tough, no doubt. It is almost as if you need a financial advisor for healthcare. Correct? Direct Primary Doctors excel at healthcare finance options and keeping healthcare costs low. We build our “dream practice,” for patients and Doctors alike, off of affordable options for our patients. Our mission is helping patients, all over the United States, achieve wellness at an affordable cost with or without insurance. Health remains our top priority and always will.
We structure our practice so any single patient, or family, can afford healthcare. No matter if your income is $40,000 or $100,000+, medical cost savings AND care are available as a DPC membership patient.
One fact that patients struggle with daily, and have figured out years ago, is that health insurance does NOT equal healthCARE. You can pay for premiums, and then co-pays, and then finally end up with a medical exam with your Physician. After that, you will most likely receive a bill UNTIL your deductible is met. And how high is your deductible? How much will you have to pay to actually receive healthCARE that is covered.
With DPC, you pay for your catastrophic premium at lower costs than a high deductible plan, and receive healthCARE from day one without co-pays or meeting a certain amount of your deductible to receive care. Your membership is a flat fee for phone calls/emails/texts to your Physician. It also covers your typical clinic visits (non-procedure visits), no matter how many are needed for the month. For example, you have a “new” medical concern such as high blood pressure. 1) You need a visit to diagnose it. 2) You start a new medication to manage it and need a follow up, performed in person or by phone (telehealth). 3) Your sensitive to medication starts and you possibly need another visit due to a complication or side effect of the medication. You are up to THREE visits already in ONE month. Your cost for Physician visits/interaction still remains your monthly fee of $65, $85, $105 per month based on your age. No extra fees for extra visits. This is how patients are able to manage lower annual out-of-pocket costs with DPC.
To help out, I have made a list of options and explanations below….it is considered “non-personalized, non-expert” guidance. Remember, I am NOT an insurance agent, nor a financial advisor. These two fields are not considered my expertise. However, the title I DO carry is Osteopathic Physician or Family Doctor. This honor was achieved after completion of twelve years in primary and secondary education, a four-year undergraduate program, along with four years in medical school, AND finally three years in a Family Practice residency program, before heading out to practice medicine in rural America.
After nine years in a traditional medical system and almost three in Direct Care, I have real-life Physician experience on healthcare costs and the medical system. On a personal level, I grew up with small town values in a “blue collar” family that used traditional insurance for healthcare. We used urban and rural clinics for our care, and my parents were like anyone else in the US, struggling to pay down the medical bills. There are days when I wonder, “what if” my parents could have had Direct Care as an option for my long history of allergies, eczema, and childhood illnesses. What if….I can make changes in this world, so a family that is similar to my own childhood experience, can achieve health and wellness with Direct Care? What if…patients catch on to this non-traditional medical system and it helps change the world and not just one family? What if????
It is the combination of the two, both personal and medical, that drive my devotion and dedication towards creating and finding affordable healthcare options for others.
Health Care Locations & Medical Coverage Options
Medical networks/clinics that the majority of billing is through insurance with insurance contracted rates. They may also may take cash-based payment or health sharing options.
2) Non-traditional, DPC (Direct Primary Care):
Majority of billing is through Cash/Debit Card/Credit Card/HSA/FSA, membership and non-membership options, WITHOUT insurance contracts. Items that CAN be submitted through insurance include things like labs, imaging, specialist appts, etc BUT the majority of the time it is cheaper to utilize the cash pay option already negotiated by the DPC.
Best paired with No Insurance, Catastrophic Plans, Health Sharing Plans, and High Deductible Insurance Plans. Occasionally, patients with a Low Deductible Insurance Plan will also choose DPC for their medical home if medical care is something they value, such as a relationship and time with their Physician, as well as a quality medical team.
3) Mixture of Both:
DPC and Traditional, Utilizing DPC for occasional acute visits when appointments are available, but keeping their traditional system medical provider for annual exams, insurance based needs, etc…
Medical Coverage Options (of note: deductibles are generalized)
1) No Insurance, All Cash/CC/DC Pay
2) High Deductible Insurance, you pay out-of-pocket until you meet your deductible. The high deductible can be upwards of $6000, even close to $10000+, for some.
3) Low Deductible Insurance, you pay out-of-pocket until you meet your deductible. The low deductible can be $500, upwards to $2500, for some.
4) Catastrophic Coverage, typically low cost premiums, used for emergencies or in settings of large medical costs such as trauma, cancer, etc
5) Health Sharing, such as organizations like Sedera, Liberty Health Share, Medishare, etc, that are not insurance companies but instead groups of individuals that share health costs when they are submitted.
Cost-Based Scenarios, Hidden Fees?
I hope the above list, and definitions, help determine the difference in traditional and non-traditional care. On to the next item, and for those, the most important one. So what are the fees for this so-called, DPC option. Usually we get asked, “this seems too good to be true, where are the hidden fees?”
For most patients, the answer to the question above is defined as soon as you have your first or second visit, as you have your “aha” moment on how our clinic membership works based on your diagnosis or amount of medical needs. However, occasionally there does seem to be some lingering confusion, and we will address this below.
Your typical Primary Care office covers primary care needs based off what your Physician does and does NOT manage. As Physicians, we are all trained to handle different scenarios, procedures, rural or urban medical care, etc…At the Healthy Human, we typically handle Primary Care and then some. We send you for Specialist Consultation when needed, but do our best to keep you in our medical home as often as possible. This eliminates travel out of town, keeps you in a medical home you are comfortable with, and decreases confusion with medical treatment plans, etc. Since we manage more than the typical Primary Care clinic, some of the additional services we offer will have an additional fee outside the membership. Look at it this way, if you were going to travel outside of your Primary Care clinic to get these medical or aesthetic needs addressed, or you were to ask about them in a traditional medical setting, you would be billed individually for these needs. We do offer discounts for all services if you are a member, but even with a discount, it is still a separate fee above and beyond your membership. Monthly invoices can be higher than predicted due to the added services within our Direct Primary Care. However, the services offered create access to medical needs that would not otherwise be possible, such as hormone therapy/management for medical conditions such as PCOS, menopause, testosterone deficiency, and aesthetic services such as Botox/Filler injections and Chemical Peels, as well as musculoskeletal therapy such as Shock Wave Therapy, OMT, and more. These are typically above and beyond Primary Care services that patients are typically referred other clinic location locations.
For example, I have listed membership and services below to explain what is included and what is not….
Memberships, $25 (18 and under), $65 (19-44), $85 (45-64), $105* (65+)
Amber Beckenhauer, DO, Board-Certified Family Physician & Founder
John Hallgren, MD, Board-Certified Family Physician, co-manages DPC patients while Dr. Beckenhauer is out of the clinic.
*Dr. Beckenhauer is the only Physician seeing Medicare patients.
This covers any traditional primary care office visits, as well as texts/emails/phone visits (Telehealth), OMT (Dr. Beckenhauer only). NO co-pays. The visits are covered in your monthly fee above, examples of diagnoses addressed may be Hypertension, Diabetes, PCOS, Birth Control refills, Annual Exams, Asthma, etc.
Extra Fees: Above and Beyond the Membership
(discounted for Members, separate pricing for NON-Members)*
Prescriptions, and/or Supplements, from the HH, we have our own Pharmacy in-house.
Labs (individual labs and/or full nutrition/hormone panels) or Imaging (X-rays, US)**
Dermatologic Procedures and/or Orthopedic Joint Injections, $60 fee for each Primary Care procedure
Colposcopy or LEEP for Abnormal Pap Smears**
GYN procedures such as Endometrial Biopsies, IUD Removal & Placement, etc
Permanent Sterilization such as Vasectomy (Members Only), Tubal Ligations with Cesarean
Novasure Endometrial Ablations for Heavy or Irregular Bleeding**
Obstetric Care, Initial Prenatal Care and Delivery (Vaginal or Cesarean) or Transfers**
Medical Aesthetic procedures such as Botox, Dermal Fillers, Chemical Peels
Skin Care Consultations with appropriate medical skin care product selection
Hormone Pellet Therapy for Men or Women
IV Fluids, Normal Saline or Nutritional, for dehydration or chronic diseases such as AutoImmune illnesses, etc
Shock Wave Therapy for plantar fasciitis, tendonitis, back pain, reducing scarring & cellulite, etc.
Platelet-Rich Plasma (PRP) injections for musculoskeletal pain such as osteoarthritis or injuries.
Platelet-Rich Fibrin (PRF) for chronic non-healing wounds.
Mental Health Counseling, individual and couples.
Nutrition Counseling, with options of daily meal planning, personalized dietary advice for medical conditions, etc.
Second Opinions or Consultations (Pay by Appointment) on Chronic Medical Conditions, Nutrition/Supplement Guidance or Weight Loss, Hormone Therapy, and more.
Geriatric Consultations (65+) for your loved ones, medication or treatment plan review, nutritional or supplement guidance, etc.
Healthy Human Protocol, 8-week Wellness Package that includes an Initial Medical Evaluation/Consultation by Dr. Beckenhauer and monthly to bi-weekly follow ups, personalized one-on-one nutrition plan, as well as fitness plan, by an HH Health Coach and Personal Trainer. (Perfect for those patients looking to keep their current Physician or HCP)
*You pay for all of these extra items or services just like you would if you went to any Pharmacy to pick up your medications (they are never included in your traditional clinic visit cost), if you were to order supplements online or pick up at a local health food store, if you were to go to a med spa for treatments, and/or see a specialized medical clinic for needs that entail medical education/training in certain medical diagnoses/conditions/surgeries.
**Some of the above costs can be billed through your insurance and can be discussed with HH.
I hope this helps everyone understand they have choices when it comes to healthcare, affordable options to maintain wellness, and the service offerings and memberships at the Healthy Human Direct Primary Care in Ashland and Blair, Nebraska.
I wish you ALL a chance at a HEALTHY and Affordable 2021, BE WELL.
Amber Beckenhauer, DO
Board-Certified Family Physician/Founder & CEO
Healthy Human DPC, Ashland & Blair
HH MedAesthetics, Blair