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The Insurance Fallacy

I am an advocate for pricing transparency in medical costs. Transparency brings down the cost of care. Would you buy a TV for $50,000 when you can buy the same one next door for $500? This is the type of price gouging that occurs in our healthcare system. The same exact medical procedure or examination with the same level of quality can be ten to 100 times more expensive depending on where you go. The worst part? You will never know or have a choice in the matter.

Insurance companies have obscured pricing so much that it is impossible for even highly educated and experienced physicians to navigate. Our patients stand no chance in understanding the cost of their own healthcare. 

Most patients operate under the impression that they pay for insurance to decrease their out of pocket medical expenses. This is a fallacy.

Fees are inflated when billed through insurance - blood tests, imaging tests, prescription medications, procedures and physician fees. As fees climb and overtesting grows, insurance premiums rise for all of us. In fact, on average, insurance premiums have risen by more than 50% in the past decade, far outpacing wages, and deductibles have doubled. More important to note, though, is that the cost of care through insurance is often much higher than the cash price.

Insurance companies have taken advantage of consumers' and employers' lack of knowledge about healthcare. We must get smarter, ask questions and explore alternative ways to consume healthcare.

In this post, I will walk you through a real life example.

Imagine how frightening it must be to find out you're pregnant when you have diabetes. This happened to one of my patients a few months after leaving my care, opting to use her insurance due to concerns over cost. She chose to re-establish care with me after realizing that her out-of-pocket costs using the insurance model were higher for lower quality of care. 

In the insurance model, she had two follow up doctor's visits and one nurse practitioner visit (despite requesting the MD) over the course of three months. Each visit was approximately 10 minutes. She also had several blood tests. The OUT-OF-POCKET doctor’s fees were $407.93 (insurance paid an additional $289.59). Her OUT-OF-POCKET lab fees were $131.93. Her total OUT-OF-POCKET cost for the three months was $539.86. 

When she returned to me, she reported that in the insurance-based clinic, she was rushed, did not receive education on improving her diet or exercise and felt hopeless and uncared for.

My heart broke for her and I hoped I could help. Physician services include much more at Complete Medicine - her initial visit was 60 minutes with me, I remotely monitor her blood sugars using a continuous blood glucose monitor, have discussed her lab results with her over the phone, we have been in touch at least weekly and I have discussed her case with her high risk pregnancy team. These higher value physician services and the exact same labs done at the insurance-based clinic would have cost her $488 over three months with me.

I started Complete Medicine, because I believe patients deserve more. I believe the patient experience should be convenient, pricing should be transparent and the focus of the visit should be on empowering my patients to their best health. Our membership based model allows for deep relationships and I have negotiated deeply discounted lab rates to reduce cost to the patient.

In short, you can get added value for less money:

And as for the experience, let’s hear it from the patient herself:

“To trust is one of the hardest things for people to do, especially if your experiences have not been good ones. I have been a type 2 diabetic for several years. Before I met Dr. Thangudu I knew nothing about this disease other than eat healthy, try to get a gastric bypass, and take metformin. I was so frustrated because I didn’t know where to start and with an A1c of 7.7%*, the future didn’t look too good for me. I happened to hear from a friend about Dr. Thangudu and her practice and was interested in the way she was doing things. Since I met Dr. Thangudu my life has completely changed. I understand what my disease is, and I know what to do to help myself. She has taken the time to educate me in a way that has made it easy to change my lifestyle. She is always available. I can call her or text her and she will reply to me the same day. I no longer have to wait months to see my doctor to communicate any concerns I have, because she is always there to guide me. Even the hardest things now seem attainable with her support. Most importantly I trust her and that is probably the biggest peace of mind I have now because I know I am in good hands. I am not just another patient walking through the door. I am valued by my physician. Thank you Dr. Thangudu for teaching me to show up for myself!”

We have created a model that is focused on you, the patient. This is what healthcare should be.

*The patient is referring to an A1c of 7.7% before her initial visit with me. She had implemented plant-based diet per my recs and brought her weight down 40 lbs and A1c to 6.9% before she re-established care. 

Disclaimer: Individual results and price may vary based on work up needed.

Author
Arti

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