Almost every day I get a new client request and essentially every one asks about insurance or Medicaid. It's interesting to me for a number of reasons, primarily because if you truly want holistic care that is individualized, then you aren't going to find that within your healthcare's list of contracted practitioners. When we sign contracts with third party payers, we have to agree to extend care in a way that meets their demands. This limits freedom of choice, because they do expect high incidence of conventional screenings and vaccines, which is why so many practices can't take clients who are more discerning about their healthcare options. Every client who declines lowers our reimbursement. When that starts at about $32 a visit and often falls to about $16, choice gets a lower priority to the practice surviving.
Not only is choice thrown out the window, but so is time. When you are earning $16 to $32 a visit and this has to cover the provider's salary, along with your assistant's and front desk personnel, coding and billing, administration, and all the overhead, then you have to churn through clients as fast as possible. In fact, the average primary care visit is just 6 minutes long.
Insurance companies negotiate not just with their contracted providers, but also with hospitals, and these negotiations ripple through the system. In effort to negotiate best prices, insurers must be able to "threaten" clinicians and hospitals in some way, which creates an imbalance of power. Historically, hospitals and clinicians are on the losing end, which ripples down to the client. We are a market-based system and I think it is clear that the healthcare consumer is not the priority - women in our country have long had the worst perinatal outcomes of all industrialized countries. Women are safer birthing in many third world countries than in the United States.
My priority truly is the client. I do value healthcare freedoms, time for connection, mutual decision-making, and bodily autonomy which is why I am integrated to work alongside the healthcare system, so you can use health insurance for labs, diagnostics, prescriptions, and file for reimbursement for my service fee or use your health savings account, but no insurance representative controls my approach to care. Your medical record is truly private.
Healthcare freedom being found almost exclusively in cash-based practices is already grossly under appreciated, but recognizing that many times insured clients actually pay more than cash-based prices is a reality most can't comprehend.
Let me give you an example.
When we first moved to Lexington, my spouse was trying to be helpful and called an area nurse practitioner so I could meet with her and see if she might be a good fit for my primary care. We didn't know if I could continue to utilize my chosen practitioner from Indiana, so many months pass by and because I had continued care with my previous practitioner, we forgot about this previously scheduled appointment until I got the reminder call. I had no idea what it was for and we had now lived in Lexington 18 months. When I asked my husband he explained that was the first appointment he could get for me after we first moved - 18 months later! She must be really amazing, right? I was quite happy with my established provider, so I canceled.
A few days later we received a letter from UKHealthCare estimating my initial out-of-pocket expenses in the event I would be a cash-based client. Keep in mind, this visit was simply to establish care as a new primary care client. I have no major health issues, except a bit of post-traumatic stress that goes unmedicated and is pretty well managed with a few therapy sessions a year, and the occasional EMDR session.
Without having gained any history yet, this letter estimated that my fees for this single consultation and predetermined labs would total $2,414.00, but they would extend me a discount of $1,448.40, so my out-of-pocket expense would be $965.60. The bulk of that was for "hospital fees" for which they have itemized as various laboratory tests.
As a clinician myself, I know the cost of these labs, or at least my own contracted fees, which I suspect are not nearly as good as larger corporations like UKHealth. However, for a lab that costs us only $1.50 for which we charge $3.00, UKHealth is charging nearly $200. That mark-up is insane! If you have an 80/20 insurance plan, then you would have to pay more out of pocket to your local hospital or insurance-based practitioner then you would for your independent, cash-based provider. It makes sense that this would be astronomical if uninsured, but that just isn't so, unless your practitioner is price-gouging you.
Because I am under contract with a local lab, I can't publicly share our contracted fees, but I can share this with clients as they seek to obtain labs, so let me share that three very common labs that I draw on most clients during their annual exams, and were billed to me in anticipation of my upcoming annual exam were priced to me for $226, $232, and $185 but our fee for those to our clients would be $25, $35, and $15.
Simply to walk into the lab cost a whopping $253.00, and drawing my labs created additional collection fees of $36 yet I know they would not allow me to request a butterfly needle, but would instead use the straight needles that cost them pennies, but hurt like bejeezus. Ironically, this charge was included twice on my bill, once for $35.00 and once for $21.00.
These mark-ups are so hospitals can pay their administrative teams high dollar salaries, which we know can be exorbitant. Billing and coding costs, physician administrative activities, and insurance administrative costs are the primary drivers of expenses in our healthcare system. It is thought that this is greatly underestimated as well.
Insurance companies make billions of dollars as well, accepting premiums, denying claim, and paying practitioners nil, so they have forced to roll that over to the consumer. Andrew Witty with UnitedHealth Group was paid $1,500,000 in salary in 2023, and had additional bonuses and incentives at $15,000,970, as well as awards of $5,000,114, a non-equity incentive plan of $1,800,000 and other compensations for $233,852. His total income in 2023 was estimated at $23,534,936. Look, I am driving a 2020 Chevy Impala without automatic start, no leather seats, no sunroof, a broken front bumper and a cracked windshield.
I just want to provide good care and make enough money to cover my dance lessons, and buy my daughter make-up. My consultations are $210 and this is likely what most everyone with insurance will pay towards their deductible each year. Labs can be billed to your insurance company, if you want to risk it, but even if that proves disastrous, we can reverse the charges and make you a cash client (unless you are Medicaid). Diagnostics can be billed to insurance, so the reality is, if you want a functional and integrative practitioner that is focused on true healthcare and you want to make your own healthcare decisions, be an active participant in your care, then that care is found with practitioners who have the freedom to practice without restrictions. As a dual certified, doctorally educated practitioner charging the same that I pay for a hair cut or massage, these prices really are doable for most people. No reason to fear a bill like the one I just received for $2,127.00 and what would that offered me since primary care visits in a conventional medicine clinic average 6 minutes?!
You would be amazed at the services we can provide, in your home, with loads of education, free yoga classes daily, hikes and book clubs, talks and true connection for less than a monthly cell phone bill. Maybe it's time to think outside the box. This isn't your standard doctor's visit and that's a good thing.
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