We get this question ALL the time – do you take insurance? The answer is no. We charge a monthly membership fee which includes all your visits and it also includes what insurance calls “non-billable time” such as coordination of care with specialists, prescription refills, transferring your prescriptions, doing prior authorizations for insurance to get the medications we prescribe, doing prior authorizations for imaging we order, doing peer-to-peers for your care to get it covered by insurance, communication with the patient in between visits if we need to check in, and more. ALL of these activities require our time, our expertise, our care, and they are all important for improvement in patient outcomes.
What would normally get billed to your insurance for a 15 minute visit in a traditional medical model (FYI we have no 15 minute visits) is about $200-$300. That is more than what a monthly fee is for us. We spend 30-90 minutes with our patients depending on what they are coming in for. Sometimes our patients need to see us more frequently, sometimes less frequently. But what they pay monthly for is access, the time we spend with them in the office, the time we spend with them out of the office, and for comfort and peace of mind they have access to ONE provider. That type of care would either be astronomically expensive to your insurance company or astronomically expensive to you if it was billed through insurance. Medical office that bills your insurance company use some *magic* BS codes, and then insurance decides whether that is an approved use or not. It’s not until months after your visit do you get a surprise bill for usually hundreds of dollars.
This not only happens for visits, but it happens for labs, imaging, procedures, surgeries, and hospital stays.
Some people see a cash pay clinics prices and think – OH MY GOSH that’s so much money! It’s actually not. Not at all. What you typically don’t see is what is billed to your insurance company. THAT is so much money. Just because cash clinics use transparent pricing with their services and labs, doesn’t mean that it’s “too much”. It means that for the first time in your life you are seeing the cost up front.
Let’s break it down for labs. This is what is typically billed to your insurance versus cash pricing we have:
Comprehensive Metabolic Panel (CMP) – a very common, basic lab for blood sugar, electrolytes, kidney and liver function.
billed to insurance – $100.75
direct cash price – $10.78
Thyroid Stimulating Hormone (TSH) – one of the most common screening test for thyroid disease.
billed to insurance – $149.28
direct cash price – $4.86
Lipid Panel – a very basic test to assess for high cholesterol and inform on cardiovascular and metabolic risk
billed to insurance – $174.28
direct cash price – $7.72
Testosterone & Sex Hormone Binding Globulin – required for testosterone prescribing and monitoring therapy
billed to insurance – $482.57
direct cash price – $46.38
Vitamin D – a commonly vitamin deficiency and important for bone health, cofactor for neurotransmitters and hormones.
billed to insurance – $258.66
direct cash price – $23.47
These are just some labs for an example of comparison. While it is almost impossible for us to give a breakdown of every cash lab we have, because we are medical providers we have access to order a lot of labs, most of them are between $3-$20. More specialized panels can be $150. Functional tests are higher dollar labs that cost anywhere from $200-$500.
It is a privilege to have access to cash labs, and that is the benefit of being part of an out of network, cash pay clinic.
Hopefully that gives a little background and insight to why we do what we do, and why cash clinics and direct primary/specialty care practices (abbreviated DPC) are becoming more popular. It affords better care for the patient, less cost to the patient, and greater clinician satisfaction.
