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Benefits of seeking care outside of insurance

The cost of health insurance premiums and the high deductibles many of us pay can feel maddening. On the flipside, declining coverage due to the high costs of coverage would leave us feeling extremely vulnerable. So, most of us pay the premiums and rarely meet our high deductibles – what we are seemingly paying for each month is peace of mind that in the event we need some type of acute care we will not be left to deal with hospital bills amounting to tens or hundreds of thousands of dollars for an unforeseen surgery or illness. For a lot of people, peace of mind is worth every penny.

Our insurance and medical systems are great for just such events, acute care.

Unfortunately, it is not a system of prevention and furthermore, it is not equipped to deal with chronic health issues outside of prescribing a pharmaceutical – a band-aid.  And so, more than 1/3 of people with insurance end up supplementing with visits to acupuncturists, functional medicine practitioners, chiropractors, and message therapists (just to name a few) that are often times not covered by insurance.

For people experiencing months or even years of symptoms, going from doctor to doctor to try and uncover what is going on, looking for a diagnosis, relief from symptoms, answers of any kind, the insurance system most often fails them. And, let’s not forget, time is very valuable. Many people spend way too long trying to make the insurance system work for them and in the end, it simply doesn’t.

A “cash pay” system opens doors for people dealing with health issues that are simply not available inside the insurance system. A cash pay system is a system where a provider has decided to opt out of accepting health insurance.

What are the benefits of a cash pay model and why should we be looking inside this health based system for answers to our ailments?

Cash pay practices offer transparent costs.

Unlike the wide swings in pricing under the insurance model, cash pay practices offer clear and transparent lab costs. It’s quite complicated but essentially, providers and insurance companies can negotiate rates privately which means there is no one standard pricing index for the cost of services or labs leaving us all scratching our heads trying to determine how to understand our invoices or bills. Most cash pay practices discuss costs of labs and other fees up front, well before any lab orders or services have been ordered or rendered. Full transparency and no confusion. And most cash pay practices offer testing at a fraction of the cost of testing through insurance.

Cash pay practices offer significantly greater time with their patients.

Accessibility is imperative for health and wellness. Your health history and story matter.

Stepping out of the insurance model means practitioners have about 16 hours more a week they can spend directly with patients and/or research as opposed to administrative time spent dealing with billing and insurance.

An insurance-based practice is designed to be a high volume-based business, causing extremely short appointment times with providers. This is one of the major problems with our current medical system. Time is essential when trying to fully understand the complex issues that people with chronic health issues are dealing with. Moving outside the insurance system means providers can spend as much time as needed with each patient.

Cash pay practices can offer comprehensive testing options and truly personalized and targeted wellness plans.

Under the insurance system, lab tests must be deemed medically necessary. Outside the insurance system, providers can run any test, any time with no need for lengthy battles with insurance companies on why a test is needed and they don’t require hard to pinpoint diagnosis codes to justify running or rerunning tests.

It is access to these comprehensive tests that help uncover as much specific information about each client as possible. This makes it much easier to see patterns and trends of dysfunction that can explain the way the patient feels (symptoms) and allows the provider to build a truly personalized plan to correct those imbalances.

Cash pay practices are more affordable in the long run.

The combination of having access to comprehensive testing and spending ample amount of time with patients really is the difference between sick care (the insurance model) and health care. You are more likely to get well outside of the insurance models pharmaceutical approach when using a functional medicine approach and a cash pay system.

Being able to get real answers and begin implementing real solutions as opposed to simply taking a drug means you will no longer be moving in and out of doctors offices at all (this ends up being expensive when you calculate time and money spent). Most functional medicine providers prioritize relationship building and client education, ensuring they are empowering their clients or patients. This means the money you spend out of pocket has an enormous return on your investment!

So, in the end, spending money out of pocket (despite having insurance) means you will more likely get answers and feel better sooner rather than (maybe) never. It’s that simple.

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