WHY USE OUR “DIRECT SPECIALIST CARE” SUBSCRIPTION PROGAM IF YOU ALREADY HAVE A HEALTH INSURANCE POLICY?
The answer is very simple. To save money in addition of getting better care. Even if you have the best health insurance policy on the market, insurance companies have come up with ways to make you spend lots money out of your pocket before they pay a dime for your care! Additionally, they have restrictions as to the care you are allowed to get even if your doctor feels that is what you need. Our program is specifically designed for patients requiring specialist care for painful conditions. Unfortunately, this program is only for patients with insurances we do not participate with. We are developing other programs for everyone.
Let’s look at the at the issues of health insurance in detail so you have a better understanding of the costs involved before they pay a dime for your care. They all use different techniques to make you believe you are buying the best policy but until you do the numbers you won’t know what your total out of pocket will be. Any policy worth the paper it is written on, the monthly premium alone is going to be $380 to $500 a month. If you are lucky and your employer offers health insurance benefits you end up paying about half of that amount every single month. Do the numbers! $190 monthly for the policy. And start adding. That’s minimum $2280 a year!
The great majority, but not all policies, will have a “yearly deductible” for each person on the policy. This can amount from $500 to $5000 or much more (I have seen it as high as $17000) depending on the policy. What does that mean? What that really means is that whatever the deductible amount is, it is your responsibility to pay it and that the insurance company does not pay a dime until you pay that amount first! And it is a yearly deductible, so it comes back every year. So, let’s say your deductible is low on the above scale. Let’s say $1600. Add that yearly! So, if you add that to your yearly premium: $2280 + $1600 = $3880.00 would be your out of pocket before they pay a dime. But wait, when you buy health insurance you also have to contend with is what they call the “copay”. This can be $25, $35, $50 or even $75 that you have to pay your doctor at every visit. Usually, the higher copays are for specialist visits. So, let’s say you go to your primary care doctor or walk-in clinic four times a year, and then you go to your cardiologist a couple of times a year and your pain specialist three time a year plus once a year to your ophthalmologist. So, all of that would add up to approximately $580 additional dollars out of pocket per year! So, adding it all up we are looking at $2280 in premiums + $1600 in deductible + $580 in copays which equals = $4460 out of pocket a year! And please notice this is with simple office visits, no catastrophic events, low monthly premium and low deductible! It could be much more. Just do the numbers using the numbers of what your own policy pays!.
To be fair, since the sum of $5040 includes the payment of the health insurance policy lets subtract what you pay for the policy $2280. So, $4460 - $2280= $2180 in deductible and copays.
One other trick insurance company throw at you is what they call co-insurance. Most commonly your co-insurance is 20% or 30%. So, you may ask, what does that mean? That means that beside all the previously mentioned out of pocket expenses, like the premium, deductible and copays, you pay 20 to 30% of the total bill. That can amount to a whole bunch of money!
With our “Direct Specialist Care” subscription plan you would spend less that. You can have up to four same day or next business day visits a month. You will see the doctor, not a nurse partitioner or PA, the doctor will not be rushed during the visit. He doesn’t have a ton of patient to run thru the revolving door. Additionally, if needed you can have up to eight injections in a year for less out of pocket money than the above-mentioned amount if you go to an insurance focus practice. Additionally, you have access to procedures not covered by any insurance such Prolotherapy and Orthobiologic procedures, at heavily discounted for our subscribers. And the best part there are no deductible, no copays and no coinsurance! You really need to seat down and do your number of that policy out of pocket expense is and consider our “Direct Specialist Care” program. They are becoming more and more popular. Check out the Direct Specialist Care Alliance website: https://dscalliance.org/search-page/?geodir_search=1&stype=gd_place&s=+&snear=32080&sgeo_lat=29.848610166964285&sgeo_lon=-81.278171815625
Insurance companies sell you a dream but make it as difficult as they can for you to take advantage of that dream. Some will not let a primary care physician refer you to specialist for as long as they can or will not let the specialist order this or that test like an MRI or CT scan for as long as they can. I have had patients come to my office with severe sciatica type pain that after I examine him/her I deem it necessary to order a lumbar spine MRI and when we call the insurance company, they will not approve the MRI until after six weeks of physical therapy. They don’t care if you suffer six more weeks. And to top that off, the person on the phone that your doctor talks to and who makes that decision about the MRI request is not even a doctor. And what’s worse is, if a diagnosis is missed because they did not approve the test and treatment is delay and you die because it was a tumor, they are not liable! You are basically screwed! They have a million tricks to save money at the expense of your health or of your suffering.
Remember insurance companies want to spend the least amount on you. That way they make more money. And so do their executive who receive huge salaries and a fat golden parachute at retirement. If you don’t believe me look at the following page and read this:
We hope that you now understand where your money is going! Is not to the doctors, nurse practitioner, physician assistants, nurses and other health professionals who actually cares for you. No, the money is going to blood sucking parasites such as health insurance executives and hospital executives, that contribute nothing to your care and their only concern are their exorbitant salaries and their golden parachute at retirement.
Another issue with insurance focus medical care, that would not be to your liking, might be that your favorite doctor is not on that insurance company panel, so you may need to change doctor. Yes, they basically pick the doctors you can go to! Like it or not.
YOU MAY ASK, WHAT HAS LED PHYSICIANS TO LOOK FOR OTHER AVENUES TO CARE FOR THEIR PATIENTS?
Dealing with health insurance companies and Medicare has become a nightmare for physicians in more ways than one. Primarily, what you as a physician detest is business people who have no medical knowledge what so ever, trying to dictate to you how to care for the patients. Their decisions are always based in saving money for the insurance company and nothing else. Haven’t you notice how quickly they spit you out of the hospital after a major surgery suck as a hip replacement or a mastectomy? That was implemented by hospitals and insurance companies, not by doctors. Secondly, physicians for the past 25 to 30 years have faced constant yearly decrease in insurance reimbursement for the care they provide even in view of constant increases in practice expenses! Thirdly, due to decreased reimbursement and increased operational cost, running a medical practice that is sustainable has become a nightmare. Dealing with insurance companies adds lots of expenses to a practice due to billing staff you have to hire to deal with all the additional paperwork. So, dealing with insurances takes you to a high-volume revolving door kind of practice where the doctor has 50 or 60 patients to see in a day to make ends meet, and neither him nor the nurse practitioner gets to spend sufficient time with the patient and where at times the patient does not see the doctor at all. Neither doctors nor nurse practitioners or Physician Assistants like this kind of practice. This insurance focus, fast pace high volume practice has become the only kind of independent practice that can survive. Patient don’ like this kind of practice either. The other choice is to sell your practice to a hospital or other entity and become someone’s employee, who will run your life raged for the purpose of making a profit for them.
Basically, Insurance Companies and Medicare have taken advantage of patients, physicians and everyone that provides medical care but fortunately for patient and physicians and everyone else, the cat is out of the bag and we are finding other avenues for medical care. They are called “Direct Specialist Care” and there are also “Direct Primary Care”.
I will attach here a post by Ron Howrigon that I found on LinkedIn. It illustrates very, very well the situations physicians have faced over the last 30 years with different insurance companies and Medicare:
"Imagine this situation. You have worked for the same company for the last 20 years. When you started in 2003 your salary was $100,000 a year. Over the last 20 years your salary has dropped to $92,000. You meet with your boss and explain that need a raise. You point out that in 2003 the Median cost of a home was $161,000 and that today the median house costs $374,000. You point out that over the last 20 years inflation has been 65% and that if your salary just kept up with inflation you should be making $165,000. Your boss listens to all of this and then informs you that he plans on cutting your salary for next year by 3.6% down to $89,000 per year.
Now at this point most of you are thinking; “Why would anyone stay working for a company like this? I would quit!” You are right. No one would continue this kind of madness. Well, no one except doctors.
These numbers reflect what Medicare has done with the physician conversion factor of the last 20 years. In 2003 the conversion factor was $36.79. In 2023 it was $33.89 which is an 8% reduction. The inflation numbers quoted above are real and accurate. So is the 3.6% reduction number because that is the proposed reduction in the conversion factor for 2024.
So, why don’t doctors just “quit Medicare”. Some don’t think they can survive without those patients (I think they are mostly wrong) but most don’t because they went into medicine to help people and these people need help and care. That just means that the government is taking advantage of physicians and the fact that they are good people who want to help people even when it’s at their own expense. "
For additional information about our practice and about our “Direct Specialist Care” subscription program, or to schedule an appointment please call our St. Augustine, Florida office at (904) 824-0955. Visit also our office website where you will find additional info at: www.TheOrthobiologicClinic.com . We also have a Facebook page for our office where from time to time we post information you may find useful at: https://www.facebook.com/TheOrthobiologicClinic.
Attached here at the end is the list of health insurances that we do and do not participate with at this time. We will be dropping out of more insurances a bit at a time. Please call to ask about your specific insurance. Patients with insurances we don’t participate with may benefit from this “Direct Specialist Care” program and save money.
Among insurances we do participate with we have the following: These patients cannot benefit from our Direct Specialist Care program. But we do offer a concierge program you may be interested in.
BC/BS PLANS ACCEPTED
Advantage 65 – Premier Select B&D (Medicare Supplement)
Advantage 65 –Select B&D (Medicare Supplement)
Advantage 65 –Select E (Medicare Supplement),
BlueMedicare Choice (Regional PPO)
BlueMedicare Group PPO (Employer PPO)
BlueMedicare Patriot (PPO)
BlueMedicare Select (PPO)
BlueMedicare Value (PPO)
BlueMedicare Value (PPO) with Level 1
BlueChoice
BlueOptions
BlueOptions Health & Dental – Health
BlueOptions Hospital Surgical Plus
BlueOptions Temporary Insurance
Preferred Patient Care
MEDICAIDE
Regular Medicaid only
MEDICARE
Regular Medicare
Medicare DME
Railroad Medicare
TRICARE
Tricare standard only
Among the insurances we do not participate with we have the following: These patients can benefit from our Direct Specialist Care program and also from our concierge program.
Commercial plans like: United Health Care, Aetna, AvMed, BC/BS HMO, Beech Street, Signa, Coventry, Dimension Plus, EHN, Florida Healthcare Plan, Great West, Humana, Multiplan PHCS, Neighborhood HealthPlan; Insurance Exchanges HIX like : Aetna QHP, AvMed entrust, Molina Market Place, Oscar Health, Sunshine-AMBETTER, United Healthcare Hix, Medicare Advantage plans like: Aetna Medicare HMO/PPO, Aetna Medicare Assure HMO, Aetna Medicare Summit HMO, AvMed Medicare HMO, Freedom Health Medicare HMO, Humana Medicare HMO, Molina Medicare HMO, Positive Healthcare SNP Medicare HMO, Preferred Care Network Medicare HMO, Preferred Care Partners Medicare HMO, Prominence Health Plan, Solis Health plan. Medicaid plans like: Aetna Medicaid HMO, Aetna FL Healthy Kids, AmeriHealth Caritas Medicaid HMO, Clear Health Alliance SNP Medicaid HMO, Community Care Plan, Florida Community Care FCC Medicaid HMO, Humana Medicaid HMO, Molina Medicaid HMO, Simply Healthcare Medicaid HMO, Simply Healthcare FL Healthy Kids HMO, Sunshine CMS Title XIX, Sunshine CMS Title XXI, Sunshine Medicaid HMO, Sunshine FL Healthy Kids HMO, United Healthcare Medicaid HMO) UNITED HEALTHCARE:Individual Exchange Benefit Plan Choice, Choice plus, NavigateCharter and Charter balance, Charter PlusCharter HMO, Charter Balance HMO, and Charter Plus HMOChoice, Choice Advanced, Choice HMO, Choice HMO AdvanceChoice plus premier, Choice plus HMO premierChoice plus with Harvard PilgrimChoice Premier, Choice with Harvard PilgrimCore, Core Essential, Core Essential PremierCore HMO and Core Essential HMO, Core premier.Doctors plan, Doctors plan HMO, Doctors plan plus HMO, Doctors plan plus Heritage plus, Heritage Select Advantage-A1Heritage Select Advantage, Heritage Select EPO, Heritage Select POS/HMO
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