It may be hard to believe but the pricing for direct pay is more often than not, less expensive than the same services in network. With the rising costs of specialty copays and deductibles (not including office procedures that often go toward a separate deductible), there can be significant savings. Paying directly for health care results in savings especially when seeking treatment at an office that caters to self-pay patients. When a health care provider creates their own fee schedule in favor of patients paying out-of-pocket, you actually win financially.
Direct Pay Model
Direct pay indicates that the patient will cover the cost of the services rendered at the end of the appointment. It may seem scary to pay the large bill yourself, but by doing so, you usually end up paying less than if you used your insurance. You can cost compare yourself and will find that it’s often less expensive to be seen by an out-of-network provider than an in-network provider.
Definition of Out-of-Network Provider
An out-of-network provider is one which has not contracted with your insurance company for reimbursement at a negotiated rate. The documentation is provided for you to submit to your insurance company for reimbursement after paying for your services at the time of your visit. With most private insurances, you will pay less than if you went to an in-network provider!
When the average specialist copay is $60 or more, if you pay out-of-pocket for your visit and get reimbursed for half of the visit as out-of-network, you get more of the payment back than if you had payed the copay. At Adult and Pediatric Dermatology, more than half our patients have found that it is cheaper to visit us as an out-of-network or non-insured patient than using an in-network provider. In effect, we work with all insurances as an out-of-network provider.
We do not require sign-up fees or membership fees unlike a concierge practice, which usually requires those fees. If you have a high deductible or high co-pay insurance plan, chances are you will find our new model will result in less out-of-pocket expenses. Most private insurances have out-of-network benefits and we can provide you will the proper statement of services so that you can submit for reimbursement. Unfortunately, if you have Medicare, you cannot be reimbursed for any of our services.
At Adult & Pediatric Dermatology, we will see everyone regardless of insurance coverage. We offer a simple, reasonable and transparent fee schedule and are happy to work with you and your insurance. If you have questions specific to you and your family, our caring professionals are here to help. Call us at 913-469-1115 today!