Edward Dieguez Jr. MD PA/Founder and Owner

Interventional Pain Management and Anesthesiology

Fellow of the Interventional Orthobiologics Foundation

Member of Physicians for Patients Protection

Uses only FDA Clear Regenerative Treatments

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.

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 insurance executives and hospital executives, that contribute nothing to your actual healthcare! So dont call it increase in healthcare. This parasites only concern are their exorbitant salaries and their golden parachute at retirement.

I will attach here, in between exclamation points and italics, a post by Ron Howrigon with his permission, 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 you 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 doctor 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.”

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. Due to these abuses with patients and the rat race type of practice that doctors have to engage in to survive in insurance base practice, many doctors are slowly getting away from insurance-based practice and transitioning into the called “Direct Specialist Care” and also “Direct Primary Care”. Enough is enough!

Here is a link you should listen to: https://www.facebook.com/reel/873362172148258

INFORMATION ABOUT OUR DIRECT SPECIALIST CARE SUBSCRIPTION PROGRAM.

First of all, since Dr. Dieguez is an Interventional Pain Physician, our program is geared toward the treatment of painful conditions without drugs or surgery and using the most advanced procedures such as Platelet Rich Plasma (PRP), Micro Fragmented Fat (MFAT), Bone Marrow Concentrate (BMC).

You can have unlimited same day or next business day visits per month. You will also have direct access to the doctor by phone or text. On your visits you will see the doctor himself, not a nurse practitioner or physician assistant. Additionally, the doctor won’t be rushed during the visit.

Additionally, if the doctor feels you need other injection like epidurals, facet block, SI joints injections etc. or another procedure not covered by any insurance like Prolotherapy, he will schedule you. And the best part is that there is no deductible, no co-pay and no co-insurance!

Also with your insurance, you may use it for lab test, x-rays, MRI, CT scans and physical therapy referrals or referral to physicians that take your insurance.

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” subscription program and save money.

Among insurances we do participate with we have the following: These patients cannot benefit from our Direct Specialist Care subscription 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, Navigate

Charter and Charter balance, Charter Plus

Charter HMO, Charter Balance HMO, and Charter Plus HMO

Choice, Choice Advanced, Choice HMO, Choice HMO Advance

Choice plus premier, Choice plus HMO premier

Choice plus with Harvard Pilgrim

Choice Premier, Choice with Harvard Pilgrim

Core, Core Essential, Core Essential Premier

Core HMO and Core Essential HMO, Core premier.

Doctors plan, Doctors plan HMO, Doctors plan plus HMO, Doctors plan plus Heritage plus, Heritage Select Advantage-A1

Heritage Select Advantage, Heritage Select EPO, Heritage Select POS/HMO

Please for more info about our Direct Specialist Care subscription program, such a prices etc., please call our office at (904) 824-0955

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Why use our Direct Specialist Care Subscription Program