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Pharmacy hidden fees

2023-02-27T03:45:36+00:00February 20th, 2023|Prescription Costs, Public Health, Uncategorized|

HIDDEN FEES AT THE PHARMACY. WHY IT MAY BE CHEAPER TO NOT TO USE YOUR INSURANCE.

“I used my insurance for birth control pills and my copay was $50. The same medication is available for $11.65 when paid in cash. That’s a difference of $38.3. How can the price be so different?”

Most Americans have insurance that offers coverage on prescription drugs, but not all medications are covered. When your pharmacy collects a copay with your prescription, you can actually end up paying more for the drug than you would have paid in cash.

Why Is My Prescription More Expensive With Insurance?

Depending on your health insurance plan and policy, you may pay more for your medication if your plan requires you to pay a set copayment to the pharmacy for your medication. Regardless of the cost of your medication, you would be responsible for this copayment, but sometimes your copay could be more costly than the medication itself.

Most of us believe that a copayment on prescriptions assumes that the insurer and the patients share the costs of the drug. However, when a copayment exceeds the cost of the medication itself, the prescription benefit manager (PBM) keeps the difference as a profit. A common example would be when you pick up a standard antibiotic or blood pressure medication which cost $4 and your copay is $10.

How Insurance Prescription Coverage Works?

Prescription coverage varies by insurance plan and the list of prescription drugs covered in a health insurance plan is called a formulary. If the medication you have been prescribed is not on the plan’s formulary, you may have to pay for that prescription out-of-pocket.
The cost of your prescriptions may depend on how the costs are factored into your deductible and your actual cost of medication is not known until the prescription is sent to the pharmacy.

Another little-known secret driving up the price of your prescriptions is known as a copay “clawback.” These are prescription drug overpayments that occur when your copayments exceeds the total cost of the drug. The insurance company tells the pharmacy what to charge. The insurance company can overcharge the consumer, forcing the pharmacy to collect that amount, and then takes the extra money back as profit. This practice is carried out through a middleman, known know as a pharmacy benefit manager, or PBM. PBM’s negotiate drug prices with drug companies on behalf of your insurer. Some PBM’s then charge a co-pay that exceeds the cash price.

Nearly half of the insured individuals whose plan doesn’t cover their prescription end up not filling their prescription. Almost one-third of insured individuals across all income groups also said that they or someone in their household was told their insurance plan would not cover a drug prescribed by their doctor.

 

https://www.healthcaredive.com/news/pbm-practices-consumers-generics-savings-USC/624702/

We’re disrupting the status quo in health care. At Roots Health DPC we believe patients deserve easily accessible health care at an affordable price. We provide excellent medical care and make it easy for patients to get the medications and services they need. Schedule a free consultation with Dr Diaz today and find out how much you can save

FIND OUT MORE!

How to Save Money on Prescriptions

Consider the following tips to optimize savings on your prescriptions:

1. Opt for the Generic Version

Opting for the generic version instead of the brand-name drug can offer huge savings. Generic medications are the same as brand-name drugs in dosage, safety, strength, route of administration quality, and intended use. The significant difference between brand name and generic is the cost. The price difference out-of-pocket comes down to the patent behind the brand name. Speak to your physician about what your options are.

2. Ask for a Different Medication

Your physician does not know which medications are on your formulary, but it is likely they are familiar with alternative drugs that are used to treat the same condition. If your prescription is not covered by your insurance and requires a hefty out-of-pocket cost, ask your physician what alternatives exist. At Roots Health DPC we help patients obtain medication at affordable prices.

3. Change Your Pharmacy

Surprisingly, the cost of your medication can vary depending on pharmacies. You can try GoodRx for your prescription if you have to pay out-of-pocket and consider changing pharmacies for a better price.

SET UP A FREE INITIAL CONSULTATION WITH DR DIAZ TODAY!

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: Keeping medications affordable

2022-06-06T13:57:34+00:00June 5th, 2022|Adults, Direct Primary Care, Health Care, Membership, Prescription Costs|

Medications do not need to be expensive.

At Roots Health DPC, we are making medications affordable for our patients. How?

We buy medications at wholesale pricing and sell them to our patients directly at wholesale cost – without marking them up. We remove the profit takers, pharmacy benefit managers, and retail pharmacies between patients and their medications, effectively lowering the cost of prescriptions by 50% to 90%.

Examples of medications for under $5/month

Medication Dosage
Metformin 1000 mg
Ibuprofen 600 mg
Lisinopril 10 mg
Amlodipine 2.5 mg
Sertraline/Zoloft 50 mg
Lovastatin 40 mg
Sumatriptan/Imitrex 100 mg
Lortadine/Claritin 10 mg

A simple idea to solve a complex problem

DPC stands for Direct Primary Care – we deliver health care services, including medications, directly to our patients. We provide medications at these rates because we believe that the people in our community deserve fair pricing on the medications they need to stay healthy. At Roots Health DPC, we are uniquely qualified to partner with our patients to determine which medications will best treat their medical conditions.

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.

 

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<<

DPC- option for quality, affordable health care during pandemic

2020-07-21T16:14:45+00:00July 21st, 2020|Deductibles, Direct Primary Care, Pandemic, Prescription Costs, Urgent Care|

Have you ever waited for an appointment or a return phone call from your doctor?

Have you gone to an urgent care and received large bills after your visit?

Have you experienced high copays and out of pocket costs for your visits and medications?

During this pandemic, your healthcare has never been more important.  If you are interested in having access to a board-certified physician 24/7 and lowering your costs, consider Roots Health DPC. Check out our savings page.

Book a free Meet and Greet with Dr Diaz today.

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