WHY USE OUR “DIRECT SPECIALIST CARE” SUBSCRIPTION PROGRAM IF YOU ARE A CHRONIC PAIN PATIENT, EVEN IF YOU ALREADY HAVE A HEALTH INSURANCE POLICY, YOU MAY ASK?

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, more specifically concierge programs for everyone.

Let’s look at the issue of health insurance in detail so you have a better understanding of the out-of-pocket cost involved before your insurance pays a dime for your care.   All health insurance companies use different techniques to make you believe you are buying the best health insurance policy, but until you do the numbers you won’t know what your total out of pocket cost will be every year. Let’s look at the details:

            1.- Monthly Insurance premium you will pay: For any policy worth the paper it is written on, your monthly premium alone is going to be around $360 to $500 every single month.If you are lucky and your employer offers health insurance benefits, you will end up paying about half of that amount every single month. Let’s do the numbers and start adding.  $180 monthly for the policy times 12 month adds up to $2160 every year!  If you are self-employed, you will pay twice that or even more.  That’s without using the policy! 

            2.- Add ons that suddenly appear when you actually use the policy: The great majority of health insurance policies have what they call a yearly “deductible”, “co-pays” and “co-insurance” and here is where they get you when you go to your doctor, or hospital or walk-in clinic. All three, deductible, co-pay and co-insurance  are for you to pay out of pocket at the doctor’s visit up front, in addition to the monthly premium you are already paying.

• Deductible. The “yearly deductible” for each person on the policy can amount from $500 to $5000 “each” or much more (I have seen it as high as $17000) depending on the policy. Until this deductible is paid, your health insurance company won’t pay a dime. And it is a yearly deductible, so it comes back every year. So, let’s do the numbers. So, besides the $2160 you spend in policy premium for a year you have to add let’s say $4000 for deductible every year. That brings your total out of pocket expense so far to $6160 !   

• Co-pays. Most policies have a co-pay that you pay at every visit. The amount may vary from $25.00, $40.00 to $75. The higher co-pays are for specialist visits. So, let’s say you go to your primary doctor five time a year and to your specialist three time per year which equals $350. That brings your total out of pocket expense so far to $6510!

• Co-insurance. One other trick some health insurance company throw at you is what they call co-insurance. Careful with this!  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 have to pay 20 to 30% of the total bill. Let’s just say as an example that for the year your total bill was $4000. Out of that you would pay 20% or $800. That would bring your total out of pocket expense for the year to $7310.

Of this total of $7310, if you subtract your monthly premium total for the year of $2160 you would save $5150 /year by not using your policy and just keeping it active for the catastrophic events that may not come maybe years down the road. You may even get a cheaper policy with lower premium to use only in catastrophic event. If you then subscribe to our “Direct Specialist Care” subscription program you would still safe money and have personalized care, and advanced Orthobiologics and Prolotherapy that are high price and which are not covered by any Insurance company.  

Please notice this insurance example cost is with simple office visits, no catastrophic events, no mayor procedures done, low monthly premiums and low deductible! It could be much more if you are self-employed or if you go to your doctor many times. Just do the numbers using the numbers that  your own policy stipulates to get a better idea! And most importantly, deductible, copays and co-insurance restart every year! 

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 if you need it for as long as they can. They don’t care if you suffer six more weeks.Also diagnostic test are delay as long as they can. 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! They basically don’t care! Most of the time the person that denies a test or a procedure that the doctor is recommending is not even a physician and sometimes not even a nurse!

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.

YOU MAY ASK, WHAT HAS LED PHYSICIANS TO LOOK FOR OTHER AVENUES, LIKE THESE DIRECT CARE SUBSCRIPTION PLAN 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.

SO, YOU MAY ASK WHERE IS THE MONEY GOING THEN? YOU ARE PAYING MORE EACH YEAR FOR YOUR INSURANCE AND THE DOCTORS ARE PAID LESS EVERY YEAR! 

Well, here is a chart that will give you an idea where the money is goin!  Is going toward huge insurance and hospital executives’ salaries and golden parachute. These are just parasite profiting and providing nothing for your actual healthcare.