Cutting out the middle man with direct pay health care

At ReforMedicine, there are two tiers of flat fees for patients' appointments
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EAU CLAIRE, Wis. (WEAU) -- Direct pay family practices are popping up across the nation and in the Chippewa Valley. It's a simple way of getting health care for your family with no surprising bill at the end.

The idea is to pay a flat fee for your treatment before you leave the doctor's office. There would be no surprising bills coming in the mail.

Doctors say direct pay can be helpful for patients with no insurance, high deductibles or health savings accounts.

In the Chippewa Valley, there are three of these clinics including ReforMedicine in Eau Claire, Parsley Medical Clinic in Eau Claire and the Joyful Doc Clinic in Menomonie. They all opened in the last three years.

Patient Jeff Knopps said he was looking for affordability and quality when he came across Dr. David Usher, MD's ReforMedicine.

"This is my second year that I've been coming here. I was in between jobs," said Knopps. "Since I didn't have insurance, it was very cost effective and the people were really great."

After working 12 years for a big provider in Eau Claire, Dr. Usher opened ReformMedicine. After he heard about the Affordable Care Act a little more than four years ago, he had a realization.

"Specifically that it would force people to higher deductible plans and there would be a lot more people who would, even though they could get their physicals for free, they would have a hard time managing chronic health problems, because of the things that were considered to be not preventative would have a big deductible that they would have to pay down before their insurance would kick in," said Usher.

He said he knew his patients would need something like this and took the bold move of starting ReforMedicine.

"Our costs generally are as much as 2/3 less than some of the large clinics are because of the way we practice," said Usher.

Just two months ago, Dr. Jennifer Parsley, DO opened her doors at Parsley Medical Clinic in Eau Claire.

"I could see the growing need for more access to health care and I could see that it was more expensive and with all the insurance plans changing, the deductibles were getting larger and larger and people were having to pay more out of pocket," said Dr. Parsley.

Her practice, like Usher's, eliminates billing, insurance companies and state and federal plans like Badgercare and Medicare.

"We eliminate all the additional expenses and we eliminate the cost of employing those people that have to do the billing and coding to do reimbursement," said Parsley.

She said doctors were seeing patients get much sicker before they went in to get health care, many holding their breath while waiting for a bill.

"One visit you may come in have your physical done and two weeks later when you get your next paycheck you may come back and have those labs you talked to your doctor about and have it done when you have that money," said Parsley.

Her patient Virginia Kuehn does have health insurance and a HSA.

"I knew the costs would be down, the overhead, therefore the expense for the treatment I was receiving would be less," said Kuehn. She said Dr. Parsley will give her a coded receipt which Kuehn would then pass onto her insurance company.

"In sending in the paperwork, it is going towards my thousand dollar deductible," said Kuehn.

Dr. Jodi Ritsch, DO said she had a moment of realization before opening the Joyful Doc Clinic in Menomonie.

"One of my teenage daughters told me she wanted to go into medicine and I felt like I really couldn't endorse that until I made some changes myself," said Ritsch. "I thought that's really kind of silly that I can't encourage people to do what I'm doing."

She didn't like how the health system made it difficult for her to manage her patients the way she wanted to. Direct pay simplified the complexity between patient and provider.

"I get to spend however much time I think is necessary to get to the bottom of things and I think that's something I didn't always have the freedom to do," said Ritsch.

She said with direct pay, people get to choose what they want and not be dictated by what the insurance company says to do.

"A lot of health care plans, people are on are real high deductible plans so you get annual exam but if you have any problems or issues that come up, you're dealing with that $3000 deducible or whatever it is, so you can see someone at the direct pay many many times to hit that $3000. When you do the math, it makes a lot of sense," said Ritsch.

All there clinics make a point about transparency in costs. You can find the prices for treatments on their websites.

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