Patients pay monthly fee, not insurance co-pay to see Raleigh physician
Posted December 18, 2015
Raleigh, N.C. — 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."