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Patients pay monthly fee, not insurance co-pay to see Raleigh physician

Posted December 18, 2015

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— Being a patient at Doctor Direct is a bit like joining a gym – pay a monthly fee and see the doctor as often as you want.

"Patients are frustrated, and they want to get a good value for their health care dollar," said Dr. Amy Walsh, who is among the pioneers of direct primary care in North Carolina.

About two dozen practices statewide use the direct primary care model, which takes insurance out of the health care financing mix.

"The only decisions I'm making is what's right and best for that patients without the red tape and intrusions that come with insurance," Walsh said. "It is a shift in how you think about your health care."

Because there's no insurance filing, there's a lot less overhead expense. Doctor Direct, which opened last month at 5838 Six Forks Road in Raleigh, consists solely of Walsh and her nurse.

Patients still need to have insurance – they face a tax penalty under the Affordable Care Act without coverage – but Walsh and other direct primary care advocates recommend high-deductible policies to cover emergencies and hospitalization.

For basic services such as preventive care and wellness checks, Walsh's patients simply sign an annual contract and pay a monthly membership fee that is based on their age – from $15 for a child to $75 to $85 for a senior citizen – and they get unlimited access to her.

"You can get a hold of Dr. Walsh 24/7, either by phone, email, text. It's a great concept. I love it," patient Fawn Smith said.

Walsh said she plans to cap her practice at 700 patients so she isn't overextended.

The North Carolina Academy of Family Physicians supports direct primary care, saying the model allows doctors to spend more time directly with their patients and provide better care.

Patients also can get lab tests, medical procedures and even prescriptions on-site, often at prices that are lower than insurance co-pays.

"I take two kinds of blood pressure medication. Before, they would cost me $43 for a month, and now they cost me $11," Smith said.

Walsh also noted that she can provide patients with a powerful antibiotic for sinus infections or bronchitis for 25 cents instead of the $25 usually charged by insurance because she negotiates directly with lab companies and pharmaceutical suppliers. When she tells them she's not working with insurance, she said, they give her a low price.

"You're not dealing with all the layers. You don't have to submit the claims, match the code and have it processed through insurance and then come back for reimbursement," she said. "Take all that red tape out, and you're dealing directly with the lab and the patient."

8 Comments

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  • Maurice Pentico Jr. Dec 20, 2015
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    My doctor did this the year Obamacare passed. Sadly I could not afford his fee. Although the patients I know of that can, really enjoy his timely and personal service. Both in Canada and the UK, there is a growing private health insurance system with private health care providers to circumvent the ailing and typically inundated social public health system. Of course you have to be able to afford it. Which can be said for ANY kind of service in the world.... its great if you can afford it. Given the higher costs of insurance, higher deductibles, longer wait times, and generally lower service... I can say MY healthcare has not gotten any better since Obamacare was enacted.

  • carlb202 Dec 20, 2015

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    They did just overhaul the insurance industry, remember? They dubbed it the Patient Protection and Affordable Care Act, which it turned out to be anything but.

  • Real Libertine Dec 19, 2015
    user avatar

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    Here's the number to a private clinic in London (020 7034 8164). Loads of them available. Clearly Daniel you've never crossed the NC border much less the Atlantic given your insular, narrow POV.

    And concierge medicine is brilliant! No one managing my healthcare experience except me and my clinician.

  • Dan Hughes Dec 19, 2015
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    LOL - That is total bull. Name one European country where this is happening (hint: you can't). Heck, I can't even find 1 non-US doctor offering this. Concierge doctors are entirely a US invention, first seen in Seattle in the mid 90s. While Private GPs do exist the vast majority of their business is non-essential-elective stuff like cosmetics, business travel vaccinations, weird-a$$-diet-plans etc.

  • Aaron Whaley Dec 19, 2015
    user avatar

    I am all for it. Insurance in this country is a racket and needs a major overhaul. For the amount of money spent on "healthcare" way too much goes into the wrong pockets.

  • Paul Donovan Dec 19, 2015
    user avatar

    This is very common in some parts of Europe where they have socialized medicine because it takes so long to be seen or treated for anything that is non life threatening. So, the ones who can afford it, also pay for this kind of arrangement so they can actually be treated in a timely manner.

  • Scott Householder Dec 19, 2015
    user avatar

    I think I'll sign up - even if I NEVER go, because we should support a system like this! It just makes since for routine care. If only the hospitals would do the same.

  • Donald Holder Dec 18, 2015
    user avatar

    My mom's doctor tried this. Not many people signed up for it and he had to go back. You would have to go to the doctor more than once a month to get your money's worth by the time you paid his fee plus the insurance. It guess if your employer isn't providing insurance, it might be worth it.