Health insurance – love it or hate it, it’s part of life. Or, at least, it has been part of life for the past century or so. Still, as many as 27.3 million people ages 65 and younger, about 10.1% of United States citizens, are uninsured.
Even those with insurance often struggle to pay for care. Between copays, deductibles, and denied claims, many Americans wonder if their insurance is even worth it. Direct primary care is one solution that can help make healthcare more affordable and accessible– allowing you to get quality primary care from a doctor you trust instead of fighting over pennies with a faceless mega-corporation.
But that begs the question: traditional healthcare vs. direct primary care – which comes out on top?
Some people are reluctant to try direct primary care, especially after a lifetime spent receiving traditional healthcare. And it’s true: your decision will be largely based on your health, budget, and preferences.
Some people even choose to maintain their insurance for emergencies and specialist visits while supplementing their plan with direct primary care. So, before you can make a choice, let’s dive into these options and how they work so that you have an in-depth understanding of both primary care models.
Note: This article is meant simply for educational purposes. It should not act as a substitute for advice from a medical professional. Reach out to Craft Concierge for direct primary care in Tampa or Tulsa to speak with a medical professional.
What is Traditional Primary Care?
Your primary care doctor is your starting point. This is your doctor who manages any chronic conditions you have, notices if anything is wrong, and offers preventative care. If you need treatment for something more serious, then they can refer you to a specialist when necessary.
Some things that your primary care doctor might do include:
Notice health issues and help you maintain a healthy lifestyle to stave off problems
Offer vaccinations
Do basic tests and screenings to catch illnesses early on
Keep track of your health history and warning signs
Referrals to specialists
Traditionally, people pay for this primary care treatment through their insurance. Maybe they got insurance through their work, they could be paying for it privately, or they might have a government health insurance program like Medicare, Social Security, or Medicaid.
The U.S. government (through CMS) is the largest healthcare provider in the United States.
How does traditional healthcare work?
Most primary care practices or doctors’ offices work through insurance. That means that they keep track of everything they do (every tool they use, every visit a patient has, and every procedure the patient gets), and they report it to insurance companies so that they can get reimbursed.
The patient usually pays a monthly fee to their insurance company (whether it comes out of their paycheck before they even see it or if they pay that amount directly or through their taxes), and then, in theory, insurance pays for their medical treatments so that they don’t have to. This should reduce the patient’s healthcare costs.
If you have insurance, then you may know that it doesn’t always end up working so smoothly. If you have insurance and you want direct primary care, then you might run into a few caveats.
- Your insurance company will usually give you a short list of primary care physicians or practices in your area where your treatment is covered. Sometimes, your insurance company will directly assign you to a primary care physician. This limits your amount of choice in the matter.
- Depending on your plan, you might be able to see your primary care physician multiple times, or you may only be allowed to see them once per year.
- If your insurance plan doesn’t cover “outpatient,” then it doesn’t cover primary care. In this case, your insurance would only start to work if you were receiving emergency care or if you were admitted to a hospital.
- Many insurance plans have a deductible. Your deductible is a minimum amount of money that you have to pay out-of-pocket before your insurance starts paying for your treatment. Sometimes deductibles are as low as a few hundred dollars, but many plans have deductibles that range well into the thousands and even tens of thousands.
- You also usually have to offer a copay when you need treatment. This is a fee that, even if insurance is paying for the treatment itself, you still pay out-of-pocket.
If you need immediate medical care, such as in an emergency, you might sometimes need to pay quickly and out-of-pocket, and then afterward, you can file a claim. A claim is when you provide receipts and request that insurance reimburse you for the amount you paid. In theory, if the treatment was covered under your plan, then they will reimburse you directly.
But many whistleblowers in the insurance world have come forward to say that insurance companies use a wide array of methods to deny their clients’ claims.
For example, Cigna is currently being sued for using an algorithm that denies claims without ever even opening them.
Blue Cross Blue Shield famously lost a lawsuit to a well-known attorney when he was diagnosed with stage-4 throat cancer, and they refused to pay for life-saving treatment, forcing him to personally pay almost $100,000 out-of-pocket for a shot at recovery.
While insurance often sounds like it works in theory, it can get a bit messy in practice. Sometimes your primary care physician is not available, or they are completely booked, or even though you pay a monthly fee to insurance, you still have to pay unexpected fees.
Many people still feel as though, despite the issues with insurance, they still need to have it because they don’t have other options. While, in those cases, insurance can act as a great security blanket, it can also make healthcare feel distant, cold, and impersonal.
A traditional primary care model offers you primary care, which is your basic, preventative, day-to-day healthcare, and relies on third-party health insurance (public or private) to cover the cost of most medical services and products. It’s been standard for healthcare in the U.S. for nearly a century. |
What is Direct Primary Care (DPC)?
However, another option for getting primary care could be direct primary care.
With direct primary care, you pay your primary care physician directly instead of paying for a third-party insurance provider. Much like insurance, you pay a monthly (or sometimes yearly) fee for your treatment plan for a membership at that direct primary care practice.
Similar to other primary care services, direct primary care covers your doctor’s appointments, labwork, lifestyle and nutrition plans, and more.
Periodic payments cover a specified list of primary care services, like annual doctor’s appointments, labwork, and more.
How does direct primary care work?
The DPC model is all about bringing choice to patients. It cuts out the “middle man,” so to speak, by removing the need for insurance that dictates how you receive care.
Most direct primary care clinics are smaller practices that can manage patient needs on an individual basis.
DPC physicians can dedicate more time to their patients by eliminating the hassle of navigating insurance payments.
By taking insurance companies out of the equation, direct primary care can differ from traditional healthcare in some particularly relevant ways.
- Through direct primary care, you can usually meet with your physician as many times as you would like. Many practices also allow you to contact your doctor at other times as well, such as by sending them messages or meeting with them via video. This establishes a trust-based, personal relationship between doctor and patient.
- Insurance companies might not cover treatments that are considered new or experimental, even if evidence overwhelmingly shows that they are effective. Direct primary care practices don’t have their “hands tied” in the same way, so they can include, in your plan, the cutting edge of medical care.
- When you pay your monthly fee with direct primary care, then you don’t have to worry about deductibles, copays, or claims. You pay for your membership, and that’s it.
- Direct primary care allows you to pay for a plan that is specific to your concerns, so you don’t have to pay for medical services that you don’t need.
How much does direct primary care cost?
All of these benefits sound great on paper, but one key question remains unclear: how much does primary care cost? It depends on the practice and the type of healthcare you seek.
Primary Care Membership
At Craft Concierge, our direct primary care membership plans start at just $150/month.
This fee covers everything from unlimited appointments to medications and laboratory tests.
Comprehensive Care Plans
We also offer a more comprehensive plan, starting at $350/month. With Comprehensive Care, you get same-day appointments, a personalized care plan, and access to our three core programs.
- The Cardiovascular Program uses new, advanced technology to monitor and improve your heart’s health.
- The Lifestyle Optimization Program uses genetic testing, coaching, nutrition testing, and more to help you build the healthiest lifestyle that you can.
- The Early Cancer Detection Program offers access to the cutting edge of early cancer detection technology so that your doctor can spot warning signs of cancer, and you can receive fast and effective treatment.
Is direct primary care worth it?
Whether or not direct primary care is worth it will depend significantly on your lifestyle and needs. If you fall into any of the following categories, then we would suggest that direct primary care is a great choice for you:
- If you have any chronic conditions, then direct primary care could be a wise investment because you have access to unlimited doctor visits.
- If you want to be able to go to the doctor frequently and be proactive about your health, then direct primary care can help significantly with getting preventative care early on instead of relying on emergency care or more expensive urgent care later on.
- Age is a significant factor in determining a person’s risk for many different illnesses and ailments. Your chances of receiving a cancer diagnosis increase significantly with age, and most cases of cancer are found in people who are 50 years old or older. You’re also about seven times more likely to have a heart attack if you are aged 64-74 than if you are 35-44. For those reasons and more, we especially suggest direct primary care for people ages 50 and older.
- People with preexisting health conditions who want to keep a close eye on their health and how it changes over time can benefit from DPC.
- Perhaps you are currently very healthy, but you know that, genetically, you might have a heightened risk of a certain disease. For someone with a genetic predisposition, DPC can help ease your mind and offer a watchful eye.
- Anyone who recognizes the value of highly personalized care could also seek out DPC.
- Of course, many people aside from those mentioned can benefit greatly from direct primary care. There are many people who recognize the flaws in an insurance-based program, or perhaps they want to supplement their insurance with DPC. Either way, we believe that direct primary care is well worth it. Your health is too important to neglect.
We want to again note that you don’t have to choose between direct primary care and insurance. Some people choose to keep both plans. For your pricing options at Craft Concierge, you can check out this page.
Remember, before making major decisions about your health and insurance, speak with a doctor to learn about your options.
A direct primary care model utilizes monthly, quarterly, or annual membership fees – not health insurance – to cover the cost of primary care. Since it doesn’t require insurance, this model offers more control over care type and frequency. |
Understanding the Benefits of Direct Primary Care
It’s clear that there are plenty of benefits of DPC that affect patients and providers alike.
Research on direct primary care models reveals that key perks like those below may help revolutionize the way we approach healthcare.
Simplified Payment Structure
Lower costs and easy-to-navigate medical expenses are chief among the benefits of direct care.
Paying for DPC is straightforward – there are no hidden fees, unexpected rules, or surprise conditions to deal with.
More Time with Your Doctor
Insurance usually requires you to limit your visits to a certain time limit and scope.
But those barriers disappear when you count on direct primary care. You don’t have to be limited to seeing your doctor once a year or restricted to certain visit times or offices.
Physicians report that this freedom benefits them, too; they can spend more time on each patient encounter, allowing them to offer better care.
Preventative Care
When it’s easy to access care when you need it, you’re less likely to wait until health symptoms become severe to ask for help.
Likewise, regular care helps providers keep a closer eye on your health, making it easier than ever to prevent unnecessary health problems.
All of this leads to more successful and engaging treatment. DPC ensures your money goes right to the services that make sense for your needs.
Direct Primary Care vs. Traditional: Which is Best?
So, when all is said and done, which primary care model is better? Where you stand on the traditional healthcare vs. direct primary care debate likely comes down to your needs and preferences.
A traditional model of primary care may be just fine for an individual with great health insurance. But many – if not most – people don’t have all-inclusive plans with affordable fees.
Even those who do still have to face limitations imposed by their insurance companies.
Many find that direct healthcare services are more efficient, faster, and affordable.
Working with the right direct primary care practice makes it simple to take care of all your primary care needs in one place.
We’d argue that direct primary care is a more approachable option for most, or at least one that’s worth considering in addition to your current healthcare plan.
Personalized Direct Primary Care at Craft Concierge
Once you decide to make the switch to direct primary care, your next step is finding the best direct care provider in your area. You should look not only for a direct care physician but a practice with the resources to support a robust care plan.
At Craft Concierge, we’re committed to redefining healthcare. Our mission is to offer accessible solutions to the struggles many face when navigating the healthcare system. Our primary physician, Dr. Amber Bazler, has the chance to get to know all patients and their preferences.
“Dr. Amber Bazler is so communicative. I can send her a text and within the hour I have a response…. What a difference! She’s spent more time with me than any other doctor I’ve had. I feel much better now knowing that my care is with the CCM team.”
- Craft Concierge patient Jim Jeffries
Craft Concierge also strives to make care stress-free. When you are dealing with health problems, that is stressful enough. You don’t need to throw arguments with an unreliable insurance provider on top of all your worries. Take advantage of unlimited same-day or next-day appointments with Craft Concierge and 24/7 virtual care so that you never have to juggle health concerns alone.
“I’ve had too many spend 28 seconds with me and prescribe a pill they may or may not be getting a kickback on! Dr. Bazler has spent time listening, provided thorough testing and has actually uncovered a pretty big secret as it relates to how my body works…which is about opposite of how I’ve been treating it for 4 decades.”
- Craft Concierge patient Holly Virden
If you’re ready to get started with direct primary care in Tampa or Tulsa, don’t wait. Contact Craft Concierge today to learn more about our Direct Primary Care program and whether it’s right for you.
