Fox DIRECT Primary Care, PLLC

Transforming Healthcare Blog

                         

AN INTERESTING ANALOGY

                          - September 19, 2019

    

Yes, this is a healthcare blog, though it may not read as such at first... I'm going to ask you to do a little creative imagining with me today. No worries. Nothing too strenuous and there won't be a quiz at the end - I promise. ;-)


I want you to think about your vehicle and all the little things it takes to keep it running. Stuff like fuel, oil, good tires, a good battery, clean filters, good belts - right? And then there are safety features such as good wiper blades and working light bulbs. Do you like to keep your vehicle looking good by washing and waxing it? Maybe you even have the interior detailed occasionally.


I know what you're thinking... you can see where this is going from miles away, right? Not so fast. I'm guessing this takes a different turn than what you are anticipating... And yes, all puns were intended.


Now, think about your car insurance and what you expect from your coverage. Do you have a good idea of those expectations in your mind?


What if, the next time you fill up your tank, you waltz in with your car insurance card in hand? Can you imagine the look on the clerk's face when you ask if they take your insurance?


But... imagine if all of the local gas stations are now taking insurance. You walk in, show your proof of insurance and voila, a claim is filed for the cost of your fuel! How convenient! After some time passes - weeks or even months - you receive a bill for the full amount from the gas station along with a denial letter indicating your insurance denied your claim. The letter candidly goes on to explain that you filled your tank with 91 octane fuel, which happens to be a Tier 3 fuel, but your plan only covers Tier 1 fuel (89 octane). Of course you call the insurance company and argue that your mechanic recommended 91 octane fuel for the health of your engine and go on to explain that your vehicle has modifications that make it imperative that you use the Tier 3 fuel. But to no avail. You end up paying for your fuel out of pocket, despite the increased cost for full coverage. Thanks a lot, insurance plan!


Sadly, you realize the next time you fill up, you'll have to make a choice between getting the fuel recommended by an expert, paying for it out of pocket, or settling for the gas your insurance will cover.


Let's consider that the next time you need an oil change, you present your insurance card. This time after a couple of months go by, you receive notification from insurance that your claim was paid. Woohoo!


But is any of this realistic? Of course not! You don't pay for car insurance to cover expected expenses. You  pay that monthly premium for assurance that, if an expensive, unexpected even occurs, you won't have to go broke trying to pay to get your car back on the road again.


So why should health insurance be any different?


Can you generally predict how much you will spend for gas and oil changes every month? Do you know about how long a good set of tires will last or when your battery might need to be replaced? And are any of these terribly costly? My guess is that most of us automatically account for these expenses and plan accordingly.


What if there was a way to easily predict an affordable, monthly healthcare cost while continuing to pay a reasonable amount for health insurance that would cover larger expenses, like ER visits, surgeries or expensive testing and treatments? What if I told you this already exists in a proven healthcare model known as

Direct Primary Care?



Food For Thought

(or a little something to chew on)


What would happen to our local gas stations and mechanics if car insurance really did cover all the smaller expenses? How would they manage waiting an undetermined amount of time to receive payment for every product and service? How would they keep adequate inventory if they had to wait for claims to be processed? May I suggest you don't have to look far to find the answers? Just take a long look at the "progress" of our country's healthcare system...










Small​ Bites

Patients using the ER in place of their regular provider is more common in the United States than most comparable countries 

Adults have quicker access to a doctor or a nurse when they need care in the United States, as compared with similar countries

The United States spends almost double the amount of the comparable country average on prescriptive medications

Deductible payments have grown more than 10 times faster than the rate of inflation in the United States in the past decade
In this wonderful insurance billing system we have, there are 71,932 separate CPT (billing codes).

If that isn't enough fun, add 16,000 different ICD10 (diagnosis) codes. Rest assured, if you are stricken by an Orca (W56.22) or sucked into a jet engine (V97.33), they've got ya covered


The number of healthcare administrators increased over 3000% from 1970 to 2009, while the number of physicians increased only 150% during that same time period