Niche care is nothing new to medicine. Even before Ala Carte providers made big news a couple of years ago, there have been many efforts by providers to bring the care as close to the patient as possible.
Employers have brought providers to the workplace to improve wellness and access to care. It can save these companies a bunch of cash on health insurance (without switching to GEICO).
We saw the development of concierge or ala carte practices a couple of years ago. These are self-contained practices that you pay a flat fee monthly to go to, and you can see a provider, have necessary diagnostic tests run and receive prescription medications right in the office. The price depends on the market and the level of service, and like any monthly bill, you must have paid your monthly fee before using the service. As a note with concierge services, you can access care as needed 24/7.
All sound convenient, because in many cases (most actually), you circumvent the headache of insurance. It is suitable for the provider because we don’t have to deal with the headache of coding, billing, and obtaining prior authorization from insurance companies.
For a provider dealing with an insurance company can be tricky, even worse when more than one is involved. Each company may require different information, which requires a staff of folks that deal with coding (using ICD-10 codes) for diagnosis as well as those who understand the billing process with insurance. Screw it up, no payment for you.
Trust me; providers often struggle to get these authorizations, get proper reimbursement for services, and often deal with the aggravation of dealing with these companies. In the end, if there is an uncovered portion, providers are forced to bill you. Insurance companies are definitely in it to make money. Nursie Poo worked in Utilization Management for a company, and they were very proud of their denial rate. I received awards for maintaining a percentage of denials as well as my aggressiveness with providers’ offices. Thinking of it now, it did two things. It made me depressed to watch patients and providers get screwed for not knowing the system and, more importantly, it opened my eyes to the big evil world of insurance, preparing me for where I am now.
So what if we skipped insurance? Wouldn’t that be great? Maybe. Out of pocket costs are through the roof thanks to greed, underinsured patients, and folks who can’t pay. One doctor in western Pennsylvania has done just that.
Because of that calculated risk, Stanley said she was thrilled only to pay $35 to see Dr. Timothy Wong, a primary care physician, who wrote her a prescription for the antibiotic.
In August, Wong opened a “micro” practice in the Pittsburgh neighborhood of East Liberty on Centre Avenue, called the iHealth Clinic.
For each medical visit, Wong charges a flat fee of just $35
In the article, it talks about patients prepaying those $35 dollars “On an iPad in the reception area.” After that, you get a basic office visit. It is questionable how any diagnostic studies are performed, but this may be just primary medical care, and anything requiring an x-ray or laboratory testing may be referred out. There are labs in the area that allow patients to obtain their blood work at their own expense. That may be how he gets diagnostic testing if needed, the article and my research on this is unclear.
Patients pay upfront, so Wong’s practice doesn’t employ a biller. And since he doesn’t accept insurance, he also doesn’t have a medical coder, which is a person whose job is to submit documentation to insurance companies. These are the reasons, said Wong, why he can charge patients so little.
Out-of-pocket costs for insured patients continue to increase, and 2019 is the first year U.S. taxpayers won’t be penalized for being uninsured. Therefore, more under-insured and uninsured patients might end up needing Wong’s low-cost care.
After reading this, I have considered doing this, and may in the future. As a provider, I would like to provide quality care to the underserved. If you have time and read this, drop a comment here or on the Facebook page and let me know what you think. I would consider doing this on a part-time basis.
Either way, be the kind of person your dog and your mom think you are.