“It depends” used to be my answer. Or “I don’t know.” When patients would ask what something would cost, I really couldn’t say. Not that I wasn’t allowed to tell them, but I truly didn’t know. Their insurance might pay everything for a procedure or a lab test, or it might refuse to pay any of it.

I would often order a standard set of labs. Some people would tell me it cost them $300 even when they used their insurance. Others said it cost them nothing, it was totally covered. Insurance companies call the shots and make the rules, which tend to be confusing (on purpose?).

This week a patient told me she had to pay $3000 for blood tests last year, since the insurance company refused. She’d had hair loss after “the” viral illness, and she had been referred to a dermatologist. The specialist put in 3 diagnosis codes for the labs, one of them being for hair loss. The patient herself works in the medical field, so she knew to contact the insurance company and complain. They told her that since ONE of the diagnoses was “hair loss,” payment was refused.

I had a similar situation a couple years ago. One of my patients was in for the usual recheck of “hypertension, diabetes, hyperlipidemia, etc” and mentioned her hair was thinning. I dutifully added the “hair loss” diagnosis code at the end of the note. Payment for the whole visit was refused!! When we investigated why, I was able to write an appeal to the insurance company and actually get paid for the work I did.

We all know that insurance can be frustrating for patients. But it’s equally stressful for medical providers. The rules keep changing.

That’s why I’m loving my new Direct Primary Care (DPC) practice, where I don’t bill insurance for services in my office. The monthly membership pays all office visits and communications. I am up front with any additional costs.

I’m able to draw blood “self pay” at a low price (about $35 or so for my typical blood tests) in my office. And yes, I will order tests, referrals and labs through outside facilities if you want, doing my best to keep your costs down as you use your insurance.

“Working for my patients instead of for insurance companies.”

McKenzie texted me this morning saying she had an abscess that was getting larger and more painful. We made an appointment for 2 pm today.

She arrived a few minutes before 2 and was immediately escorted back to the exam room. I had the abscess drained, and she was on her way by 2:15. No rushing her through. In fact I enjoy myself when I get to drain abscesses. (I know people think I’m pretty crazy to like that, but I just grin.) She was happy to be done and on her way in just a few minutes.

I love being able to provide that kind of service in my unique DPC (Direct Primary Care) medical practice. Since McKenzie pays a monthly membership, all office visits are included. So the abscess visit didn’t cost her anything extra at all.

Karen’s car was so unreliable! It was frustrating how it would let her down when she needed it most. She had a doctor’s appointment she was looking forward to. She had a list of things she wanted to discuss, hoping to come up with a game plan for how to feel better and get off some of her medications. But now she had a flat tire! She would have to reschedule that appointment.

She called Pine Creek Family Medicine and told Sue that she wouldn’t be able to make it. To Karen’s surprise, Sue offered, “Dr. Herrington can just give you a call, and you can have your appointment that way.”

Karen remembered having a virtual visit at her old doctor’s office. She had to connect by video, which didn’t work too well. First her phone wouldn’t connect, then the image and sound were stilted, so she and the doctor would end up talking over each other, or they would just stare at each other waiting for the other person to talk. She preferred a phone call, but there was some issue with her insurance not paying for “phone visits” so they had to involve video.

Karen voiced her concern, saying she would rather not have a video visit. Sue reassured her that a phone call was just fine, since the office didn’t have to worry about insurance requirements. Karen’s monthly Direct Primary Care membership covered all office visits and communications.

“Yes, that would be great!” she said, pulling out her list of questions.

Ethel called yesterday. The night before she had sudden onset of a harsh cough and chills. I happened to answer the phone (people are often surprised when the doctor answers the office phone), I asked some questions, and we came up with a plan. She said she would send her boyfriend to come pick up some medicine at the office. Well, before I had even finished documenting our conversation, her boyfriend had shown up. A few minutes later he was on his way with written instructions, as well as suggestions on how to keep himself healthy after having been exposed to the illness. I talked with Ethel again this morning. She’s doing well, but we have plans to talk again tomorrow to make sure she’s doing ok through this illness.

In my previous traditional medicine practice, I would have been so busy that Ethel’s calls would have gone through the secretaries, to the nurse, then to me or another provider, then back through the nurse to the patient. Each doctor might have different ways to treat illnesses, so the advice could vary. And finding time to check with her the next day could be challenging in among a full schedule of patients and phone calls.

I love the prompt personalized care that I can provide for my patients through this Direct Primary Care model of medicine. Working for my patients instead of for the insurance companies.

I love de-prescribing… taking people off medicines that they don’t seem to need. Many times they feel much better!

Today I saw Mindy (not her real name) for her third visit with me. Last time we had discussed the cough that she had for more than 6 months. Nothing was helping the cough, despite taking 4 medications every day to try to stop it. I realized one of her medications was probably causing the cough. So we stopped that as well as 2 of the cough medications. Today she said that cough is totally resolved. We’re stopping the other 2 cough medications, and I expect she should be fine without them.

Like many of my patients, Mindy has a laundry list of medical problems and medications. One medicine could be causing symptoms such as aches and pains, which leads to more prescriptions to help with the pains. It is also hard to know which medications interact. Each person is different. There are very few people on the exact same collection of medications. So I’m working individually with each of my patients trying to figure out what medicines are needed and what could potentially be stopped.

I also have learned over the years that diet makes a big difference. Eating whole foods and decreasing processed foods can make a huge difference in how people feel. It can help them control their diabetes, high blood pressure and other issues, which can lead to even more de-prescribing, taking them off medications. In traditional medicine people are told that once they have an illness, they’re basically stuck with it. But I have seen otherwise.

I love my DPC (Direct Primary Care) practice where I work for my patients instead of for insurance companies.

Bob (not his real name) needed a form completed for work. Height, weight, lab results, BP etc.

In my old office, he would have had to drop it off, where it might take a few days to make it to staff who filled in the numbers, then to the doctor for a signature. There might have been a charge for the paperwork. Or maybe his doctor would want him seen to fill out the paper. It could take several days or longer to get an appointment, then he would sit in the waiting room for a while before finally having the brief appointment.

Another reason to love my DPC (Direct Primary Care) practice. Bob sent us a message this morning asking if we could complete the paperwork. Sure! Stop in after work today. I weighed him, checked his BP, filled in the forms, chatted with him a few minutes, and sent him on his way. Total time: 15 min at most. Cost? Nothing extra – it’s included in his DPC membership as one of our patients.

Are you afraid to ask a question when you’re at your yearly physical appointment with your doctor? Have you ever been charged extra for asking about a cough, or that your blood pressure isn’t controlled, or you asked whether you might have an infection?

In traditional medicine, there are all kinds of regulations from insurance companies. The yearly physical includes certain components which we must address. And if we document a couple issues that are not included in the routine physical, it’s FRAUD if we don’t bill for the extra issues! It’s like providing free care for all the extra answers. We can’t provide free care to some and charge other people. We can get in trouble if we charge too little or charge too much. We must submit “codes” that document what services we provide. We spend a lot of time justifying ourselves to the insurance companies, hoping they will pay us for our work.

That’s why it’s SO freeing for me to have my own DPC (Direct Primary Care) practice. I don’t answer to insurance companies. If someone asks me about a splinter, I pull out my magnification and take a look, removing the splinter if needed. A price list from a traditional practice says the charge for “remove foreign body subcutaneous simple” (removing a splinter) is $260! What do I charge? Nothing extra – it’s included in the DPC membership.

With DPC, patients pay a monthly membership, and all office visits and communication are included. And we develop a personalized doctor-patient relationship. I’m working for my patients, instead of the insurance companies.

Joe (not his real name) was disgusted with his doctor’s office. He couldn’t get a timely answer to his questions, and getting an appointment with his doctor was quite a struggle. When he did get to see his doctor, she concentrated on the computer much of the visit. He felt like she scooted him out the door before he was ready. He needed some tests done, but he had to call his doctor’s office several times before the tests were finally scheduled.

He called our office on a Friday, surprised when I, Dr. Herrington, answered the phone. Sue, my one employee, was out mowing the lawn (which she loves, by the way). Joe explained some of his problems, and I offered an appointment for that afternoon. With him in the office, I filled two pages of notes and together we came up with some plans. I checked the clock – we had been together face-to-face for 90 minutes! That’s about 10 times the usual time with doctors!

When I was in traditional medicine, I used to struggle with rushing from one patient to the next, trying to give them enough time while not making the next people wait excessively long. With DPC (Direct Primary Care), doctors usually see about 5 to 10 patients per day rather than the usual 20 patients per day. It gives me time for personalized health care for my patients. I’m loving it! Medicine the way it should be.

Everyone loves Sue. I don’t really have a title for her, but she’s my one and only employee, my front office staff, my friend. She loves to mow the lawn and clean the office. She has painted the bathroom. We eat lunch together every day and have lots of great conversations. Patients love her. She is pleasant and positive.

At our previous office, she was the scheduler, making appointments for tests and specialists. It was a tough job. I think that’s why she loves the diversity at my office. Oh, and we also have tons of windows at our office, which makes both of us happy.

She proved herself golden a couple days ago. My patient needed to see a cardiologist, and she requested a specific doctor. Well, that might be a tough request, taking months to get into him. But as the patient waited, Sue called cardiology, and within a minute she had made an appointment NEXT WEEK for that patient! Wow! And from our end of the conversation it was obvious that the cardiology staff was thrilled to hear from her. They love her too.

Last time you were sick, how long did it take you to get an answer from your doctor’s office?

How long did it take to get an appointment?

Did you see your own doctor, or did you need to see someone else?

Were you able to be seen in the office if desired?

At Pine Creek Family Medicine we are seeing our patients the same day if needed, either in person or virtually. Patients see me, Dr. Herrington, exclusively, which helps me stay on top of their issues. I don’t have to re-create what someone else has done for them at our office. And by having fewer patients (I plan to have about 500 rather than the typical 2000 patients), I have time to take good care of my patients and get to know them well. Best of all, all office visits and communication are included in the monthly membership fee, so there are no hidden charges. No need to hesitate to contact me for advice.

When I was in traditional medicine, there were certain insurances that required we connect by Video Visit rather than just a phone call, or we wouldn’t get reimbursed as well (I never could remember which insurance had which requirement). But with my DPC (Direct Primary Care), I don’t bill insurance, so I can pick up the phone and just talk to my patients, or communicate in any way we desire.

Medicine the way it should be.