What Is Direct Care Anyway?

What is direct care anyway? 

Direct care is a practice model where the physician contracts directly with the patient with no insurance middle person. 

The physician sets their prices and the patient pays it. Kind of like everything else in the world. We also contract with labs and imaging centers to provide patients with discounted pricing on testing.

Imagine going to the grocery store and finding that all of the prices were removed from the food items for sale. You are then told to put whatever you want or need in your cart and you’ll be sent a bill in a few months after you consume it. 

That sounds absolutely ridiculous, right? 

Of course the grocery store would take advantage of customers in this model! 

Well, that is the exact system of US healthcare. We order the test usually with no clue about the cost. The patient goes and gets the test done. They are then sent a bill weeks to months later, often a bill that is 10-100x the cost of the actual cash price of the test. If they have not met their deductible they are responsible for the insurance “negotiated” price. Spoiler alert - it is not negotiated in the patient’s favor. Insurance barriers with networks, PBM’s, formularies, coinsurance, individual vs family deductibles make this system far too complicated for even doctors to understand - how can we expect our patients to?

Direct care offers transparency in pricing that we all need.