Direct-pay practice: Ensure patients know financial risks

Although direct-pay primary care is now more affordable to the masses, many patients remain at financial risk should they need specialty or hospital care not covered by practice membership fees, according to an article from KHI News Service.

AtlasMD in Wichita, Kansas, for example, charges a monthly membership fee of $10 for children and $50 for adults for unlimited visits, texts, phone calls, discounted prescription medications and in-office services and procedures. Josh Umbehr, M.D., who has run the practice since 2010, recommends that patients combine their membership with catastrophic care health insurance with a $5,000 deductible.

But Claire McAndrew, private insurance program director for the group Families USA, noted that even with the lower-premium coverage, some patients take a bigger risk than they realize. "People are young and healthy until they're young and fall ill, or they're young and get into an accident," McAndrew said. "I think that's a pretty big gamble for young people to take."

However, Umbehr points out that in the rare instance a patient would pay an entire $5,000 deductible out-of-pocket, he or she would still likely come out ahead financially compared to paying $200 per month in premiums for life. Umbehr, who is running for lieutenant governor as a Libertarian with his father, Alma attorney Keen Umbehr, told reporters that he is "still doing the math" on whether the state, which is not expanding Medicaid eligibility, should move its 400,000 Medicaid recipients to a direct primary care plan if he and his dad are elected. Nonetheless, part of his platform is to advance the cause of direct primary care, he said.

To ensure patients understand that practice membership does not replace insurance, Ryan Neuhofel, who runs a direct primary care practice in Lawrence, Kansas, requires all new patients sign a form stating that they understand his recommendation to pair his plan with some type of insurance. However, he estimated that about 70 percent of his patients are uninsured and come to him because they can't afford a comprehensive insurance plan.

But without carrying at least catastrophic care coverage, patients will face penalties at tax time, as the Affordable Care Act states that a concierge plan paired with catastrophic care insurance qualifies as "wrap-around" coverage, while a practice membership alone does not.

To learn more:
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