We operate our office as a “Direct Pay” practice. Direct pay, along with concierge medical practices are becoming increasingly common across the United States. Sometimes referred to as “private medicine”, the idea is that we work for you, and you directly pay us for the services you use. We don’t work for insurance companies, or hospitals, or the government. We work for you. Although there may be various reasons why physicians are increasingly setting up this type of practice, the following page explains the reason why WE do this, and more about what this means.
What a direct pay practice offers
More care. We can spend more of our time with patients. A serious issue facing healthcare is the ever expanding amount of things required that don’t directly relate to your actual care. Doctors are increasingly being required by a third-party (such as the government or an insurance company) to perform functions and complete checklists unrelated to treating patients. Being a direct pay provider means that we are not buried in unnecessary paperwork, nor are we required to do things unrelated to your actual care.
More efficient means lower costs. Less of our time is spent doing burdensome administrative tasks that result in little or no benefit for you or us. Under the traditional system, medical practices typically need a large staff to comply with regulations and ensure that they are reimbursed by health insurers. Most estimates show that a practice spends 30 percent or more of its time and money simply trying to collect payments from insurance companies. Bypassing this directly lowers our cost of operating a practice. In addition to this, we’ve taken great care to cut our overhead and extraneous costs to the bare minimum, so that we can both keep our office running and bring you the lowest-cost care possible. The result is that you can have a visit with our doctor for a fraction of the price of a typical appointment.
More freedom. Practicing this way gives us the freedom to collaborate with patients and to provide the best treatment, period. Unfortunately, there can be times where a physician cannot do something that would be beneficial because an insurance company doesn’t approve. Often they don’t approve because the care doesn’t meet some complicated metric or one-size-fits-all “model” which has been deemed to be “appropriate care” by people unfamiliar with your situation. And sadly, sometimes the insurance company doesn’t approve simply because they don’t want to pay for that care. At our practice, the only people who will decide the type of care that you receive will be you and your doctor.
More transparent. One frustration of the current system is that nobody can really tell you how much something is going to cost. With our model, you know, in advance, exactly what your care will cost.
More private. The collection, reporting, and analysis of your medical information and electronic data has become big business in healthcare over the past few years. While this may have the potential for benefits, it also raises profound concerns. Our practice is not required to comply with any mandates regarding government reporting so your medical record remains your private record.
What a direct pay practice doesn’t offer
The direct pay model works by charging you less because we eliminate the insurance companies as the middleman in your healthcare. You will pay a fraction of what we’d have to charge under the traditional model, however, if you are insured, you will have to submit claims to and interact with your insurance company yourself. We don’t bill insurance, or coordinate your care with insurance companies in any way. Note that although we don’t submit claims directly to your insurer, we are always happy to provide you with detailed paperwork/receipts that you can then submit to your insurance carrier.
Transparent and straight-forward pricing
We want you to be able to plan, and we believe that simple, transparent pricing is one of the main advantages in a direct pay model. With our office, there should never be any unpleasant surprises. You can know, in advance, exactly how much you care will cost. For more information, see our pricing page.
Why have we chosen to do this
The answer is, simply: We believe that this type of practice is not only better for us, but also better for you. Many physicians, including Dr. Geidl, are concerned about the future of medicine, and agree that insurance and government mandates/regulations are interfering with our ability to deliver the best care possible. This situation can lead to physician burnout, and in some instances doctors are leaving medicine altogether. Even though many physicians cannot do things differently, a direct pay practice gives us the opportunity to do so. This model allows Dr. Geidl to continue doing what she loves, and deliver the best care to as many people as she can.
How this affects you
There are several areas where our direct pay practice may affect you:
1. You should be prepared to pay for your visit, in full, at the time of service.
2. We do not participate with, and are not “in network” with any insurers. If you are insured, we are glad to provide you appropriate paperwork, but you will need to submit for reimbursement to your insurance company.
3. If you have insurance with a copay-only for office visits, the visit itself will probably cost you a bit more than a normal doctor visit. However, please keep in mind that there is a high cost to obesity and other metabolic conditions. Beyond the direct cost of yet another weight loss program, or diet products and supplements, there are also indirect costs that must be considered. For example, it is not uncommon for our patients to significantly reduce their medication usage, as well as need less medical care (both of which will result in a noticeable reduction in overall money spent). Also, in general, being healthier means less sick days or unpaid time off work. Finally, while not being something that you can put a price on, we ask patients to consider the value of feeling better and being well. What is that worth to you?
4. If you have a high-deductible healthcare plan, it is likely that visits to our direct pay practice will cost you significantly less than seeing an insurance-based provider. This is due to the simple fact that until your deductible has been reached, you are basically a “cash pay” customer at your doctor’s office. When you consider the accumulated effect of thousands of dollars of expensive appointments, plus coinsurance after your deductible has been met, our low and simple pricing structure should result in less expensive care.
5. All patients are encouraged to carry insurance, at least a high-deductible healthcare plan to provide for catastrophic care. However, if you have no insurance, you will likely find that visits to our direct pay practice will cost significantly less than seeing an insurance-based provider.