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Apex physician doesn't accept health insurance

Posted December 20, 2010
Updated December 21, 2010

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— A medical practice in Apex does what few in America do: It doesn't accept payment through health insurance coverage.

Dr. Brian Forrest opened Access Healthcare in 2002 to make health care more affordable for people without insurance.

The practice displays fees for individual services – $49 for a physical and $30 for a cholesterol test, for example – in the waiting room. Patients pay upfront for the various services in what is called the "direct pay model."

"We don't file or accept insurance of any type," Forrest said recently, noting that eliminating the paperwork involved with insurance claims saves his practice about $250,000 a year.

"If you were to go to a traditional office, you see someone who's filing insurance, somebody who's doing the billing, somebody who's doing the coding," he said.

Access Healthcare's staff includes only a receptionist, a medical assistant and a nurse practitioner in addition to Forrest and another physician.

"We can pass those savings directly onto the patients," Forrest said. "(Our) prices are generally 80 to 85 percent less than what they're going to be in traditional medical settings."

He compared the system to owning a car.

People have automobile insurance for a collision or a breakdown. Likewise, people should have health insurance for catastrophic illnesses or surgery, he said.

Yet, people don't use auto insurance to pay for vehicle maintenance, he said. They shop around for the best price and service, and the same model could be applied to health care.

Forrest said about half of his patients have health insurance and file their own claims after paying the Access Healthcare bill.

Physician generic, health checkup Apex physician doesn't accept insurance

"Many times, our services are priced so low they can actually be less expensive for them to come there than to go somewhere and use their in-network coverage," he said.

Patient Cathy Boggs said she has used Access Healthcare for eight years and called the care Forrest and his staff provide excellent.

"There are no surprises. You know what you're getting. You know what you're spending for it," patient Boggs said. "You wouldn't buy clothes and not ask how much it costs before you go to the counter or look to see. Why should medicine be any different?"

Forrest also has built a network of specialists with which he has negotiated discounted rates for his patients who will pay cash up front. The network will provide services like mammograms and MRIs, for example, so people who don't have insurance can get medical tests or treatments they need by working out payments they can afford.

Not dealing with insurance allows more time with patients, Forrest said, noting that he schedules just one patient per hour.

"Having more time improves quality," he said.

The direct-pay model accomplishes what many people want out of health care reform – increased access for the uninsured, decreased costs and price transparency – and he said another 250 such practices nationwide will open up with or convert to the model in the next 18 months, including more than 10 in North Carolina.

48 Comments

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  • chasey Dec 22, 6:16 p.m.

    I have read the comments posted here, and while i agree this is a good idea in theory there are a LOT of holes in it. For example the article says:
    Forrest also has built a network of specialists with which he has negotiated discounted rates for his patients who will pay cash up front

    This business is this mans personal business, so of course he is free to run it any way he chooses. But to charge your patients differently based on cash payments seems very shady.
    doctors/providers/facilities all know what the insurance companies will pay for a given procedure, usually it is based on the UCR (usual and customary rate). so the biller purposefully OVERbills the ins co, who then forces participating doctors to do their write offs.

    I work with medical claims all day everday, and will see, very often, where providers will submit the SAME service, same day, to different insurance companies with DIFFERENT fees

    so you go to the grocery store and buy bread, for the person in front of you, a

  • fmaon06 Dec 22, 11:54 a.m.

    "If the pharmacies didn't file, just like this doctor, people would see how much their meds cost and it would raise a huge outcry against the drug companies. People would demand more generics driving the price of name-brand drugs down."

    Drug companies have a monopoly on the drug as soon as they file a patent on it, which lasts for 20 years. This is before clinical trials though, so a patent roughly lasts for about 7-12 years while the drug is on market. The manufacturer can set whatever prices they need to offset the BILLIONS of dollars it took to develop the drug. After the patent is up, the generic companies swoop in and use the same active ingredient, but change the fillers and excipients. They still have to run clinical trials, but they're not as intensive because the drug has already been proven to be effective.

    And that is why brand drugs are so expensive and it takes a while for generics to come into play.

    Source: pharmacy technician and pharmaceutical sciences student

  • superman Dec 21, 3:42 p.m.

    If it sounds too good to be true-- move on. I go to a doctor in Apex, they accept insurance. He always takes his time and never rushes me out and answers questions. Furthermore if you do go to a doctor and you are not satisfied with his services, rates etc. you are always free to change doctors. Thats your choice. Insurance companies are so slow to pay so I cant blame doctors if they dont want to accept that. If you go to see Dr. Forrest and the service you require is going to be expensive-- you might just wish you were going to a doctor that accepts insurance. Do his patients have medical insurance and do they feel so comfortable with his practice that they dont have any?

  • genralwayne Dec 21, 1:21 p.m.

    "... then I file to my insurance company and get the money BACK over and above my 20.00 co pay. Sounds like a win win situation. I pay what the Doctor orders and then get a refund."

    You've obviously never filed a medical insurance claim before. Good Luck!

  • stupiditydeservesnosympathy Dec 21, 1:21 p.m.

    Direct patient pay, catastrophic insurance coverage, significantly expanded HSA's (instead of contracted in the health care bill) and significant tort reform to reign in malpractice claims is all we really need. The poor will be covered by charity care and low cost clinics.
    luvbailey

    What lala land do you live in? The working poor are always the ones who lose out. Real health reform is include services for those who work but can't afford to shell out hundreds up front for services. FYI it can take months to be seen at a charity care clinic-- if there is one in your area. Kinda sucks when a person has a real medical issue and can't get an appointment till 3 months later. Lack of health care reform is why sick people have to come to work instead of taking the day off.

  • davidgnews Dec 21, 12:42 p.m.

    Gary, they do lab panels too (info on their website).

  • davidgnews Dec 21, 12:35 p.m.

    This is awesome. We need much more of this, and more physicians to lead the way. They'll better-control their own destiny and take it out of the hands of insurance and government. It's a total win-win for patients and caregivers.

    Dr. Forrest should get more recognition for his efforts -kudos!!

  • Lerxst Dec 21, 11:53 a.m.

    "get the money BACK over and above my 20.00 co pay"

    Um...there would be no co-pay. You pay him directly the full amount and submit to your ins. for reimbursement if you so desire.

  • Mr William Dec 21, 11:46 a.m.

    Is there an equivalent for getting lab work done, special tests?

  • teklc Dec 21, 11:44 a.m.

    So if I go to this Doctor and pay 49.00 for a physcial and whatever for cholesterol check, then I file to my insurance company and get the money BACK over and above my 20.00 co pay. Sounds like a win win situation. I pay what the Doctor orders and then get a refund.

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