In this next installment on understanding the cost of primary care, I’m going to present an example involving the cost for a typical child to receive care for sore throat symptoms. As in the last example, I’ll try and show the cost of care for those with high deductible insurance, those with no insurance, those going to a retail healthcare outlet, and those enrolled in the Direct Primary Care program. I hope to highlight the real cost of each program.
Example:
Jon is the typical 6-year-old boy. He loves to play LEGOs with his dad and chase his dog in the back yard. He recently started 1st grade and still hasn’t mastered good hand washing. He can do it when he’s reminded but it’s easy to forget. Last night he told his mom that his head was hurting but didn’t have a fever. When he woke up this morning he was burning up. His mom measured a fever of 102F and found his tonsils were swollen and red. Jon didn’t want to eat the pancakes his mom made for breakfast because his throat hurt too bad. It turns out that one of his friends at the last birthday party developed similar symptoms and were diagnosed with strep throat by their pediatrician.
Let’s again consider the four scenarios in turn.
If Jon’s parents bring him to Trinity Medical Associates and have a High Deductible Health Plan (HDHP) then
Office visit (99213) charge: $85
Rapid Strep Test charge: $15
Total charge: $100
The insurance negotiated price is about 80% of charges so his parents will pay $80 out-of-pocket by using a HDHP insurance.
If Jon’s parents bring him to Trinity medical Associates and have no insurance then
Office visit (99213) charge: $85
Rapid Strep Test charge: $15
Total charge: $100
Trinity offers the same 80% negotiated rate to self-pay patients if they pay in full at the time of service so his parents will a pay $80 out-of-pocket if they don’t have insurance.
If Jon’s parents seek out care from a retail clinic provider then
thankfully for these more simple problems the pricing is much easier to figure out.
The Little Clinic posts prices as follows:
Sore throat focused visit charge: $85
Rapid Strep test charge: $20
Total charge: $105
So his parents will pay $105 out-of-pocket if the go to this retail clinic and have a HDHP or no insurance.
If Jon’s parents have him enrolled in Trinity’s Direct Primary Care program then
they owe nothing more than the $30 per month membership fee. In fact the $80-105 they spent seeking care elsewhere would cover 2.6-3.5 months of membership. So by spending the same amount of money on membership they could be seen for this episode of strep throat and any other episodes of strep throat for over 3 months. It includes all the other phone calls and emails and follow-up visit that might be needed to sort through these symptoms as well any other problems.
What happens when Jon’s parents have questions after the visit? What happens when they need to know the dose of Motrin, or when he can go back to school, or why Jon suddenly developed rust-colored urine and his ankles are swelling?
Primary care needs to be about the ongoing issues of your life. Doctors and patients need to be able to have a continual conversation about their life and health and concerns.
No one can predict the future, so we all need a good plan to have the right people by our side when trouble comes. Trinity’s Direct Primary Care program is one way we hope to make sure we can stay by your side through the troubles of your life.
mbm