Direct Care

Direct primary care practices offer a membership-based approach to routine and preventive care that can dramatically reduce health care costs for individuals, families and businesses. At the core of a direct primary care facility is a medical practice dedicated to providing routine, everyday care, essential for the well-being and ongoing maintenance of a patient’s health. This is where patients go for check-ups, vaccinations, sprained ankles, or frequent headaches. Direct primary care providers know their patients. They have talked with their patients in detail, gotten to know them, treated past conditions and know what recurring problems are experienced. If a patient has a chronic illness, like arthritis or diabetes, their primary care provider is already a partner in management every step of the way. And, in the unlikely event of a life-threatening accident or disease, the provider serves as the patients advocate, coordinating care across multiple providers, facilities, and prescriptions. Direct primary care practices serve as a patient’s primary care medical home where they go for all routine primary, preventive and chronic care management types of care. Patients pay one low monthly fee to their direct primary care facility for all of their everyday health needs. Like a health club membership, this fee gives patients unrestricted access for visits and care, so patients can use the services as much or as little as they want. Many direct primary care practices are open seven days per week and offer same-day or next-day appointments. At many clinics, physicians are on call 365/24/7. There is none of the paperwork and expense required today by insurance reimbursement - no procedure or billing approval, deductibles or co-payments. With a lower business overhead and dramatically less paperwork, primary care providers are no longer forced to squeeze in an unmanageable number of patients and can instead take the time necessary with each patient to deliver high-quality, personalized care. Accidents and the unexpected do happen, so the typical patient in a direct primary care practice keeps an insurance plan to cover emergencies and serious illnesses. Because this insurance does not need to cover routine care, many patients choose a less comprehensive plan with a higher deductible and lower premium. With insurance-paid primary care, where each and every part of the medical care is billed to a third party payer, reimbursement costs consume more than 40 cents of each dollar. Eliminating insurance from primary care makes those 40 cents available for actual health care - more time with each patient, more extensive office hours, more on-site services and diagnostics, and more patient-provider support technology. The patient and dire provider are responsible for the overall wellness. Any time have a health concern, the first visit should be to the primary care provider, who knows all of the medical history and can help make the best decision about the health. With most health issues, the primary care provider can diagnose and heal the problems thee experiencing. Specialist and hospital care should be for serious, complex illnesses and life-threatening emergencies. If one is severely injured in an accident, for example, an ambulance takes to the emergency room. Or, if thee diagnosed with cancer, may need hospital care such as surgery, radiation, or other treatments. Insurance is an important part of specialist and hospital care. Similar to automobile insurance, our health insurance system was originally designed to pay for rare, unpredictable, and extremely expensive problems. It is essential when patients need emergency care or an operation and chemotherapy treatments, care provided by specialists and hospitals. Primary care is frequent, highly predictable, and relatively inexpensive. It doesn’t make sense to pay for primary care using insurance. Paying for primary care with insurance has caused the cost of primary care and the downstream specialist/hospital care to rise considerably, and has made health care cost-prohibitive for millions of Americans. Direct primary care practices eliminate insurance overhead, which can extend health care to more Americans.

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Private Pay Health

 Private Pay is the basis upon which the healthcare financing system began. Patients paid physicians a fee-for-service. In its purest sense, the Private Pay model includes only the physician and patient in the exchange of compensation for medical care provided. Over the years as healthcare financing arrangements have changed, entities paying a fee-for-service includes all payers-public and private. Recently, the healthcare industry has referred to physician practices that do not accept health insurance as cash-only practices or Private Pay offices. Private Pay vastly reduces the traditional overhead expenses by not having to bill and abide by contractual requirements of third party payers. Further, collection rates may be higher with fewer bad debt expenses. Physicians in a pure Private Pay practice may want to continue to see patients with private insurance who are willing to pay cash and submit their own claims. Before charging privately insured patients on a cash basis, the physician should determine that there are no contractual or legal restrictions on doing so. This will necessitate a review of existing contracts and state insurance regulations. Certain states protect enrollee’s in particular private insurance plans from being billed for any sums beyond what the insurance company pays, except for co-pays and deductibles. Opponents of a completely Private Pay practice model would argue that it violates the professional principle of ensuring equal access for all. Individuals with insurance may not be able to afford seeing a physician who does not participate with their health plan due to the added financial responsibilities. Thus, the Private Pay practice is limiting its level of patients’ access to care based on one’s financial means. There are already millions of Americans who cannot afford private health insurance and have Medicaid coverage. Others self-insure due to their financial resources being such that they can pay out-of-pocket for their medical expenses. Physicians who wish to move to a pure Private Pay practice and still take Medicare patients must privately contract with such patients. If still accepting Medicare, it is advisable to follow the Medicare fee schedule as to avoid causing any red flags to be raised. The rules related to treating Medicaid patients on a Private Pay basis will vary from state to state. It is advisable to contact the state Medicaid agency for their terms on charging patients directly. Beverly Hills Body Surgery provides body lift plastic surgeon and plastic surgery information around Los Angeles and Beverly Hills areas of California. Plastic Surgeon in Beverly Hills Ca serving Los Angeles offers cosmetic and plastic surgery including breast augmentation, liposuction, face lift surgery.