IS DIRECT PAY RIGHT FOR YOU?

What do you want?  You want good medical care with as little out of pocket cost as possible. Figuring out how to do that is hard when insurance rules are all over the map.

There are three things you need to know:

     *What are the rules for your insurance (deductible, copay, approved services)?

     *What are the costs in an office that takes your insurance (participating)?

     *What are the costs in a direct pay office?


Here are some examples (please keep in mind, the charges at participating offices may be much higher, depending on how they code):

EXAMPLE 1:  You have a bleeding spot on your upper back. You are worried it might be cancer.

     You go in and are examined, have a biopsy, and then are treated for a basal cell cancer.

The insurance-approved costs are:  new patient visit ($110), biopsy ($105), pathology reading ($114), and treatment of the cancer ($173).

The direct pay costs are:  short visit ($50), biopsy (included), pathology reading ($50), and treatment of the cancer ($50).


     Great insurance (no deductible, $20 copay for office visits):  At $40, you most likely will choose to use your insurance.

     Average insurance ($500 deductible, 20% copay):  Depends on whether you've met your deductible.  If you have had no medical expenses, you will pay the entire $502.  If you have already spent $500 on medical care, you will pay $100.  Direct pay costs less if you haven't met your deductible, but more if you have.

     High-deductible insurance ($3000 deductible):  Obviously, you go with the $150 direct pay instead of using your insurance and paying $502.



EXAMPLE 2:  You bring in your daughter for treatment of her acne.  Her first visit includes the new patient office visit, treatment plan and prescriptions, and an acne peel.  Two weeks later, she returns just for a second peel.
Insurance approved costs are:  new patient visit ($110), acne surgery ($103), and the second acne surgery ($103)

Direct pay costs are:  regular visit ($80), first peel (included), second peel ($20)


     Great insurance (no deductible, $20 copay for office visits):  At $40, if cost is the main concern, you use your insurance.
     Average insurance ($500 deductible, 20% copay):  Again, it depends on whether you've met your deductible.  If you have had no medical expenses, you will pay the entire $316.  If you have already spent $500 on medical care, you will pay $63.  Direct pay costs less if you haven't met your deductible, but more if you have..
     High-deductible insurance ($3000 deductible):  It makes more sense to go with the $100 direct pay instead of using your insurance and paying $316.


*If you submit your receipt, some insurance companies will reimburse for covered services.*



EXAMPLE 3:  You have a $75 specialist co-pay (this is becoming quite common).

You are almost always better off coming to Holland Dermatology.  Some of your visits will cost just $50, and you won't have the hassle of filling out forms and waiting every time you come in.


How much is your time worth?

Sometimes, money is only one consideration.  If time is tight, an office where you can be sure of getting in and out quickly may have value to you, too.  Also, Dr. Holland does not typically recommend frequent visits.  Once a good program to control acne is in place, she usually prescribes a year’s worth of refills.

 
Still not sure if Holland Dermatology is a good fit?  Ask our staff – we truly do want what is best for you.

Call 734-288-3383

Jean Holland Dermatology

Jean M. Holland, MD, FAAD