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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.

 

Circling back: The Pandemic. Navigating Your Health Today.

2021-08-31T13:59:18+00:00August 31st, 2021|Adults, Coronavirus, Covid-19 Testing, Membership, Pandemic, Vaccine|

As the Delta strain sweeps across our country many of the measures to prevent spread are being reinstated. Most would agree, whenever we make progress in life, it is usually “2 steps forward and one step back.” Dealing with a novel coronavirus is no different.

The vaccines have been highly effective. They continue to give vaccinated persons protection by keeping vaccinated individuals out of the hospitals as this more virulent Delta variant spreads. This is witnessed across the country where the hospitalizations and deaths are afflicting the unvaccinated population heavily.

As the Delta variant continues to circulate and cases climb, we now know that vaccinated individuals can transmit the Delta variant to unvaccinated. We must again choose to protect our most vulnerable by wearing masks in public spaces, avoiding large indoor gatherings, spacing 6 feet, and getting tested. This time around, Covid testing is more widely available and there are rapid tests that can be done in the comfort of your own home.

I recommend Bimax now Antigen test, but would like to make you aware of the rapid testing limitations. The test works well if you have symptoms and it is a positive result. However, if you have been exposed you will need a PCR test 4-5days after exposure. If you have symptoms and a negative rapid test result you will also require a PCR test.

Our patients at Roots Health DPC are able to obtain PCR testing when they need it and it is sent to the lab for results. More importantly, each individual receives personalized and specific recommendations for their unique situation. Can you imagine navigating covid without a board-certified physician available to answer questions?

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 … we all deserve better health care. The foundation for improved health outcomes lies in the rebuilding of a solid physician-patient relationship and unlimited access to your physician when you need it. How we get through it all… will always depend on… who we get through it all with.

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<<

Staying well during a Pandemic

2021-05-08T13:05:37+00:00September 4th, 2020|Direct Primary Care, Family Medicine, Membership, Pandemic, Telemedicine|

 

What is different about Direct Primary Care?

For the past 6 months, most of us avoided going into enclosed spaces with sick people. For this very reason, many people do not feel safe going to an urgent care or traditional medical office. Unfortunately, our health care needs do not disappear during a pandemic. Neglecting our necessary urgent and routine health care needs can lead to poor outcomes. What is the best way to address this problem?

Virtual care and limiting the number of in-person office visits are solutions we have implemented, at Roots Health DPC, to keep our patients safe while providing necessary care. We offer unlimited text, phone, and telemedicine availability. We limit our in-person office visits, take necessary precautions to decrease transmission of the virus, and thoroughly disinfect between patients. Home visits are also available to members. The direct primary care (DPC) model places patients first and removes the mal-aligned incentives that accompany the health insurance model. DPC focuses on providing accessible and personalized health care. It provides patients with the affordable transparent pricing they want and the safe delivery of the health care they need.

>>>Reach out and set up a free Meet and Greet with Dr Diaz at Roots Health DPC<<<

>>>Read about how direct care practices are perfectly positioned to help patients during coronavirus outbreak<<<

 

Roots Health DPC – Part of the solution

2021-05-08T13:20:44+00:00August 28th, 2020|Community, Direct Primary Care, Family Medicine, Membership, Pandemic|

 

 

Your Health is more important now than ever before.

Our communities continue to struggle to handle this pandemic and I have more questions than answers.  What will be the long term effects on the bodies of patients who have had Covid-19?  How will we ensure that children have appropriate social-emotional development and education? Who will bear the economic burden of a failed health care system?

If I spend too much time in the future, I become quickly overwhelmed.  What I believe is true, is that we have today.  Today, I am grateful for my health, nutritious meals, my home, and my family.  I can take action today, to take care of myself physically and emotionally.  I can ensure my body gets the sleep and exercise that it needs. I can take precautions to protect my health and well-being and I can reach out to others in service.

I created Roots Health DPC to be part of the solution for a broken health care system.  I believe people deserve health care that is affordable with transparent pricing. I know that sick patients have improved outcomes when they have a physician who advocates on their behalf.  It is my belief that patients and physicians should be the only ones involved in medical decision-making and that third party intrusions actually make outcomes worse and increase costs.  This becomes evident when we look at US health care spending and mortality rates.

I encourage you to take action today to take care of yourself and your family.  As a member of Roots Health DPC, you can be reassured that you have unlimited access to your physician at all times in the event that you or a loved one becomes ill.  When we are sick, we are not able to advocate well for ourselves.  As a patient or caregiver you might question whether you or your loved one needs an evaluation urgently.  As a board-certified physician with experience in Emergency Medicine, I can evaluate and assess your health care needs quickly and accurately to help you navigate difficult health concerns.  Roots Health DPC members have virtually unlimited access to their physician and they find a strong health care advocate by their side when they are in need.

I encourage you to consider enrollment in Roots Health DPC and join the health care solution to build healthy families and communities.   Set up a time to meet me, Dr Diaz, and learn more.

Modern medicine with old school service

2021-05-13T18:06:02+00:00August 12th, 2020|Direct Primary Care, Family Medicine, Membership, Pandemic|

The pandemic has made one thing very clear. The health care system is broken. At a time when people most need health care to be available and affordable to them, the pandemic has highlighted the current inefficiencies, limitations, and obscene costs to individuals who need that very same care. One could even argue that the corporate health care industry is doing more harm than good.

Having a trusted primary care physician that patients can speak with directly when they have concerns or questions is important. Direct Primary Care (DPC) is a new model of healthcare that addresses the accessibility, quality, and affordability of health care in this country. It is modern medicine with old school service. DPC provides higher quality care by answering questions, evaluating patients urgently as needed, and helping patients navigate uncertainty. DPC operates on a monthly membership fee schedule, free of insurance constraints, allowing patients to engage in health care that is both higher in quality and more convenient.

What is different about DIRECT PRIMARY CARE (DPC)?

2020-08-04T13:38:46+00:00August 4th, 2020|Direct Primary Care, Family Medicine, Membership, Telemedicine|

Have you ever had a direct line to your physician?  Not a mid-level or answering service.  Continuous access to answers about your health as your medical needs dictate, not as your ability to get an appointment dictates.  Telemedicine, phone, email, text has always been an integral part of communication in DPC and supplements in person visits.  DPC has known for years that communication is one of the foundational blocks for excellent health care.  Your health care needs are addressed by your physician and follow up care is meticulously coordinated for your benefit.

Over the years, I can attest to how difficult it is for patients to navigate the complex health care system when health care needs arise.  The coordination of care between providers and different health care systems are poor at best and this leaves patients with unanswered questions and often inadequate care.

At Roots Health DPC we prioritize the patient-physician relationship.  We make sure your health care is accessible, personalized, and affordable.  Book a free Meet and Greet with Dr. Diaz to learn more.

https://www.forbes.com/sites/katherinerestrepo/2017/09/18/telemedicine-pairs-well-with-direct-primary-care/

One of the defining characteristics of DPC is that these physicians keep their practices small so they can spend more time with their patients. Telemedicine further restores their physician-patient relationship by extending access to health care beyond the exam room.

Coronavirus in our Community

2020-07-29T14:23:41+00:00July 29th, 2020|Community, Direct Primary Care, Family Medicine, Membership, Pandemic|

During the pandemic, and as we enter the second wave, I am grateful to live in Illinois. Our state implemented strict measures that curbed the rampant spread of the disease early in the course and I am confident that the people of Illinois will continue to take measures to decrease the spread of this virus. There are many things beyond our control during this pandemic and there are still many unknowns. Wearing masks, social distancing, and washing hands are the things that each person does have an ability, and in fact a responsibility, to do, to control the spread.

I wanted to share with you this recently published article in JAMA CARDIOLOGY.
https://jamanetwork.com/journals/jamacardiology/fullarticle/2768916

In this group of patients it was demonstrated that there is cardiac involvement in 78% of patients months after the diagnosis of COVID-19. These patients had a mean age of 49 and the heart complications occurred independent of the severity/course of the illness and regardless of underlying conditions. We still need more information on the long-term effects of this virus.

Please continue to take precautions now as the numbers begin to increase. If you are sick with fever, cough, congestion, sore throat, body aches, stomach flu, new rash, or loss of smell please obtain testing and quarantine until you have the results. It is recommended that when you are in quarantine you do not visit others or go out of your home until your test results are determined. If you are a member of Roots Health DPC please call us so that we can arrange for your appropriate care.

Stay safe and be well.

Natasha Diaz, MD

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