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Mondays with your MD – Open Enrollment is Here

2022-11-12T02:13:13+00:00November 5th, 2022|Adults, Copays, Deductibles, Direct Primary Care, Family Practice, Health Care, Membership, Prescription Costs|

The THINGS you DID NOT EVEN THINK to consider this Open Enrollment…..

How can I keep my costs low AND receive high quality accessible health care?

Every year we pay more for insurance while less and less is covered. When we attempt to use our insurance it is cumbersome and inconvenient at best. We have all experienced the frustration with the amount of time it requires to obtain what we need for our health and get it covered by insurance. Today we cover the basics and empower you to make decisions that will give you the most cost-effective way to obtain the high quality health care you deserve

The Jargon

Premium: the amount you pay every month for health insurance.
Deductible: the amount you must pay before you can get any services covered by your insurance in a calendar year. A few Caveats to the deductible: Not everything counts towards your deductible. Premiums and copays generally don’t count. Some plans have separate deductibles for prescriptions.

Copay: a fixed amount you pay for a covered expense (visits, procedures, medications, etc)
Out-of-pocket maximum: the most you might have to spend for covered services in a given year. This number is important to understand!
HDHP is a High-deductible Health Plan (HDHP): these plans offer lower monthly premiums and allow you qualify for a Health Savings Account (HSA)
HSA is a Health Savings Account: A type of savings account that lets you set aside money on a pre-tax basis to pay for qualified medical expenses.
Health Share Plans*: this is not an insurance product and offers much lower monthly premiums with low initial unshareable amount (similar to a deductible). *A cooperative where members “share” medical costs. They cover catastrophic needs (hospital stay, surgery, ER visit, etc) but are not insurance products.

What your typical open enrollment conversation is missing!!!

Smart consumers determine their out of pocket projected cost for the year and choose a high deductible plan to save on monthly premiums. Savvy consumers understand the relationship between premiums and deductibles and keep costs low by determining the most cost-effective way to lower their out of pocket-expenses over the course of the entire year.

REMEMBER HEALTH CARE DOES NOT NEED TO BE EXPENSIVE.

Direct Primary Care: The impossible Made Simple and Transparent.

Direct Primary Care (DPC) removes insurance companies from the physician-patient relationship and provides the vast majority of health care services through a low monthly fee (like a gym membership). Patients skip the hassle of traditional insurance-based care. They get more time with their physician with same day and next day appointments… all without copays or hidden fees. DPC can produce tremendous savings on out of pocket expenses when patients work with their DPC physician to find the most cost-effective appropriate health care. The enormous savings on medications, labs, and imaging often exceed the annual cost of membership.

Can you imagine if you could have easily accessible high quality health care with access to your doctor whenever you needed it AND pay less out of pocket? Have a cough and fever but dont want to go to the urgent care? ….. skip the line and the copay! Urinary tract infection while on vacation out of state?…. no problem we got you covered.

“Dr Diaz is accountable and easy to reach. I feel well taken care of and trust I am in good hands.“ – M.C.

M.C. saved 97% on her bloodwork.
Imagine getting 97% OFF… you read that right! This patient had labs with Roots Health DPC and paid $29.57. The same patient had the exact same labs billed (for the same tests) at a price of $901.24 through the same lab.

At Roots Health DPC we get it. Your health and wellness are our main goal and we are here to support our patients as they make decisions that will affect their well-being.

Open enrollment only comes once per year… make the most of it and choose the best plan to meet your health care needs.
Its your money.
Its your healthcare.
Its your choice.

If you want to learn more about how direct primary care can help you achieve your health care goals and save you money, sign up for our free guide:
“Better Healthcare for a Fraction of the Price”

Mondays with Your MD: Health Insurance is not Good Health Care

2022-05-22T19:04:31+00:00May 22nd, 2022|Adults, Copays, Family Practice, Health Care, Membership|

How accessible is health care in the richest nation? Why Health Insurance ≠ Health Care.

Many patients tell me that they love their doctor but that they cannot get through easily or book an appointment quickly. They pay thousands of dollars annually for “health insurance,” but are frustrated with their inability to access appropriate “health care.” Patients often go to an emergency room or an urgent care to be seen because it is the only option in the existing health care model.

The result: Americans visits the doctor less frequently and have the highest rate of avoidable deaths.

The United States spends 2x as much, per person, as other high-income countries, yet the US continues to have the lowest life expectancy and poorer health care outcomes when compared to other countries. Americans pay hefty premiums to health insurance plans every year. Where do the dollars go and why is health care access awful?

Traditional physician offices incur a large cost for taking care of patient needs outside of the actual patient office visit. For example, making a phone call to provide patient care is not compensated by insurance companies. Several other similar services that are instrumental to good health care include completing forms for patients, ordering and/or reviewing labs, and writing prescriptions. Restrictions placed by insurance companies make it difficult to take care of patients outside of the visit.

What if health insurance was the same as other insurance products?

A good example is car insurance. You expect to pay out of pocket for your gas, oil change, and maintenance/repairs. You have a high deductible low premium insurance that covers you in case of a car accident. In the analogous healthcare model, patients have catastrophic health insurance coverage with low monthly premiums and a high deductible.

Pairing health insurance with health care, through a physician direct primary care office, lowers out of pocket expense and improves health outcomes by providing access to obtain discounted screenings, preventative services, urgent care services, labs, and medications.

Health insurance companies have come between patients and their health. The health system in the United States is broken as evidenced by the out of control spending and health outcomes. Direct primary care offers an alternative that works. Direct primary care aligns values to prioritize patient health care needs with lower costs and better health outcomes. Find a direct primary care near you by searching https://mapper.dpcfrontier.com/

Mondays with Your MD: Transparent Pricing is your Right

2022-05-09T12:04:16+00:00May 7th, 2022|Copays, Deductibles, Direct Primary Care, Membership, Prescription Costs|

Your Rights

We all know that transparent pricing in health care services is rare. It can be different now.

In the traditional health care system, patients often asked me why they had received outrageous bills for their medical care and what they could do about it. I got tired of watching patients struggle with medical bills. I felt powerless in my ability to deliver the health care my patients deserved. Even worse, I knew that the financial health of my patients directly affected their physical and emotional health.

Did you know that medical bills are the most common cause for U.S. bankruptcies? Common sense would dictate that transparent pricing is an integral part of excellent health care.

Most hospitals are still NOT compliant with posting prices to their website even though it has been a law since Jan 1,2021! It is now your right to know the financial implications of the care that you receive.

Excellent health care does not have to be expensive.

There are numerous services that allow you to compare the price of health care. One of my favorite sites is “turquoise.health” where the cost of local medical procedures/tests can be compared.

I believe patients should always know how much a service will cost be before they receive care.

 

An Example…

At Roots Health DPC, we negotiate lab costs directly with the laboratory and obtain lab studies at significantly discounted prices which are listed on our website. Shortly after we opened our doors we charged one of our first patients $32.45 for a panel of standard labs. When that patient received another bill for $927.86 from the lab she contacted the lab directly and was offered a “self-pay” discount of $250.00. Since the bill was an error, ultimately she did not incur a charge at all. The value of this experience was priceless for my patient and myself as we realized just how wildly variable pricing can be, and just how little transparency exists.

No one deserves to be saddled with an insurmountable pile of medical bills.

All of us deserve transparent pricing and, in fact, it is our right.

 

The Pandemic. Deferred wellness. Navigating health today.

2021-05-13T18:23:04+00:00May 8th, 2021|Community, Copays, Deductibles, Direct Primary Care, Family Medicine, Membership, Pandemic, Telemedicine, Urgent Care|

As we pass one year since the pandemic started, it is time to take stock of our overall health and what it means to us as individuals.  It’s important to note the collateral effects that the COVID-19 pandemic has had on our individual health as well as the overall wellness of our community.  Many avoided or delayed care (both urgent and routine) to lower the risk of acquiring COVID-19.   We now have evidence that this shift has led to delayed diagnosis and treatment which results in poor outcomes.

While we can celebrate some success as the number of vaccinated individuals increases in the United States, we still struggle with effects of social isolation and the surge of mental health problems that accompany it.

Prior to the pandemic, it was common for patients to avoid the “hassle” of the traditional health care system. Patients disliked the “big production” around getting an appointment and waiting to be seen as well as the amount of time and energy spent to engage with the insurance-based model of care. Often patients delayed care because the cost was not transparent and surprise billing was never popular.  Between copays, deductibles and out-of-pocket maximums most people have no idea what costs to expect when they seek the care that is recommended.

The pandemic has accentuated the difficulties of getting care… we have witnessed that our health care system is beyond broken.  It does not serve patients and the time for change is past due.

What if getting care was as easy as scheduling online and speaking directly to your doctor via phone text or email whenever needed?  What if there was no “hassle” to get an appointment and no wait to see your doctor?  The Direct Primary Care (DPC) model has made this a reality.  Your physician is easily accessible with time to address all your health concerns.  DPC is the future of health care and is championed by physicians around the country dedicated to doing what is best for their patients.  DPC takes away the “pain” of seeing the doctor.  It emphasizes the value of the patient-physician relationship and creates space for shared decision-making around health and wellness.  DPC provides excellent care, transparent pricing, and unparalleled accessibility.

During the pandemic, DPC patients had unlimited access to their physician.  They were engaged in healthcare prevention and maintenance conversations with their physicians.  They received superior care by having direct communication with their physician.  There were no “surprise” bills because DPC membership fees are transparent and extremely affordable.

As with anything difficult, we can always find a silver-lining… and we must if we want to continue to grow and improve. The pandemic has made the case for DPC.  We all deserve better health care. The foundation for improved health outcomes lies in the rebuilding of a solid physician-patient relationship.  How we get through it all… will always depend on… who we get through it all with.

>>LEARN MORE ABOUT ROOTS HEALTH DPC<<

>>Click here to call ROOTS now 708-613-7916<<

Open Enrollment – Information

2021-05-08T12:59:32+00:00October 14th, 2020|Copays, Deductibles, Direct Primary Care, Family Practice, Membership, Prescription Costs|

 

OPEN ENROLLMENT…. IS JUST AROUND THE CORNER!
Whether your health insurance is through your employer or you have a private policy, you’re headed for open enrollment. This is when insurers make cost and benefit changes that will be effective January 1 st . Your insurer is required to notify you in writing of upcoming plan benefit changes. Take the time to study those changes and the benefit details in any plan you are considering for your 2021 coverage. The choice you make will be in effect through December 31, 2021 unless you have a qualifying event, (such as loss of coverage) that allows you to change coverage mid-year.

Here are three common changes to look for:

  1. Increased Costs: An increase in your premiums and/or what you pay for medical treatment, such as: lab work, x-rays, or hospitalization. Direct primary care members receive enormous savings on labs and imaging servicess.
  2. Prescription Drugs: Two common benefit changes for the drugs you take are:
    i. They are no longer covered. Direct primary care members are offered steeply discounted medication pricing.
    ii. The drugs have been moved to a different tier, which often means moving from a lower-cost tier, such as Brand Name, to a higher cost tier, like Specialty Drugs.
  3. Physician services. Many times with changes to insurance, patients find their physician is no longer “in-network.” Check that your specialists are still in network. Good news…direct primary care physician services are not affected by these changes.

Choosing the plan with the highest deductible/lowest premium can save thousands of dollars per year when paired with a direct primary care membership. You never have to worry about your changes to your direct health care services regardless of benefit changes in the policy. Open enrollment only comes once per year. Make the most of it and choose the best plan to meet your health care needs.

TRANSITIONING JOBS/ LAPSE IN HEALTH BENEFITS?
Direct Primary Care offers an excellent opportunity to obtain health care with transparent pricing that covers the vast majority of health care needs. We recommended you maintain catastrophic coverage. Some good options are:

  1. Short-term health insurance (STHI): as of mid-2020 there were at least 9 providers of STHI in Illinois.
  2. Medical Cost Sharing Plans

>>LEARN MORE ABOUT ROOTS HEALTH DPC<<

>>Click here to call ROOTS now 708-613-7916<<

© Copyright 2020 Roots-MD LLC, dba Roots Health DPC
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