Direct Care vs. Concierge Medicine: What’s the Difference — and Which One Offers the Best Value?
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In today’s fragmented healthcare system, even the most educated, high-achieving women find themselves wondering: Why is my medical bill so high? Why can’t I ever see my doctor when I need to? Isn’t there a better way?
There is. In this episode of Endocrine Matters, Dr. Arti Thangudu breaks down two rising models of care — direct care and concierge medicine — and why understanding the difference could save you thousands, improve your health, and give you more control than ever before.
🎧 Listen now → Apple, Spotify, YouTube
Why Traditional Insurance-Based Care Fails Patients
The current system is full of hidden costs, surprise bills, and poor access. Patients are left in the dark about pricing, and physicians are buried under paperwork and insurance restrictions.
Hospitals and insurance companies benefit from this lack of transparency — but patients pay the price. Literally.
Concierge Medicine: Access, But Still Tied to Insurance
Concierge medicine charges an annual or monthly membership fee in exchange for benefits like:
Same-day appointments
Longer visits
Direct messaging with your doctor
But most concierge practices still bill your insurance for labs, imaging, and procedures. So you’re paying on top of what your insurance bills — without knowing how much anything costs until the bill arrives.
It’s better access, but not true transparency.
Direct Care: Simplicity, Savings, and Full Transparency
Direct care takes insurance out of the picture entirely. You pay your doctor directly — either per visit or through a flat monthly fee. That means:
✅ No surprise bills
✅ No prior authorizations
✅ No inflated hospital pricing
✅ Transparent pricing for labs, imaging, and prescriptions
At Complete Medicine, Dr. Thangudu’s direct specialty care clinic, a lab test that might cost $2,000 at a hospital can be offered for under $10. That’s the power of cutting out the middlemen.
Direct Care vs. Concierge Medicine: Key Differences
Bonus Tip: Pair Direct Care with a Cost-Share Program
Want the benefits of insurance without the high premiums and confusion? Pair direct care with a cost-share program like Sedera. It’s designed to cover big, unexpected expenses like surgeries or hospitalizations — at a fraction of the cost of traditional insurance.
Employers can do this too. Dr. Thangudu’s company, HeyHealthy, partners with businesses to provide affordable, preventive care to keep employees healthy and out of hospitals.
Transparency = Empowerment
When you know what care costs upfront, you can plan, budget, and prioritize your health without fear. And when your doctor isn’t tied to insurance company rules, they can spend more time with you and truly personalize your care.
🧠 Want to stop playing defense with your health?
💻 Learn more about Complete Medicine’s direct care model
FAQ: Direct Care, Concierge Medicine, and Getting the Care You Deserve
1. Can I get reimbursed by my insurance? 1.
Yes. We provide itemized invoices with appropriate CPT and ICD-10 codes that you can submit to your insurance for potential out-of-network reimbursement. To make the process easier, we’ve partnered with Reimbursify, an app that helps patients file claims with just a few clicks — because we know dealing with insurance companies can be just as frustrating for you as it is for us.
2. Is this alternative medicine?
No. At Complete Medicine, we practice evidence-based medicine grounded in the latest clinical guidelines from organizations like the American Diabetes Association, the Endocrine Society, and the North American Menopause Society. All care is delivered by board-certified endocrinologists who specialize in hormone and metabolic health. We simply cut out the middlemen — not the science.
3. Why should I pay out-of-network for my provider?
If you value:
More time with your doctor
Endocrinology expertise that goes beyond “just managing labs”
Transparent pricing
Convenient scheduling and communication
Proactive care that prevents complications instead of just reacting to them
...then this model is likely a great fit for you. If your priority is staying within an insurance network even if it means longer wait times, shorter visits, and less clarity, that’s your choice to make. We’re here for people who want more from their healthcare.
4. How is direct care different from concierge medicine?
In concierge medicine, you pay a monthly or annual membership on top of insurance billing — which means you may still get surprise bills for labs or imaging. In direct care, there’s no insurance billing at all. You pay your doctor directly, and pricing is clear and fixed before any services are rendered. That means no middlemen, no surprise costs, and no insurance interference.
5. Can I use HSA or FSA funds for this care?
Yes. Most patients can use Health Savings Accounts (HSA) or Flexible Spending Accounts (FSA) to pay for our services. Always confirm with your account provider, but direct specialty care is generally considered an eligible medical expense.
6. Will this replace my insurance?
No — we recommend that you still carry some form of catastrophic coverage for emergencies, hospitalizations, or surgeries. Many of our patients pair our care with cost-sharing programs like Sedera or employer-sponsored plans. Our model is designed to cover the majority of your routine and specialty care with less stress and more control.
📍 Still have questions?
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