Direct Pay Offers Transparency and Affordability to Health Benefits

| Health Benefits

Direct Pay Offers Transparency and Affordability to Health Benefits

 

Under the traditional health insurance model, we all know that an office copay serves as the first of several financial hurdles that have rendered coverage unaffordable for so many working Americans. It’s followed by an annual deductible designed to further reduce utilization and offload risk onto the patient, as well as coinsurance that adds yet another layer onto the billing cycle. The final tab isn’t known at the point of service.

When tallying up all the out-of-pocket costs, the provider may end up collecting $100 spread out over a month or more for that single visit. The effort involves countless hours of submitting paperwork and clawing back the difference between that initial copay and coinsurance with a high deductible serving as the backdrop.

So why not just pay the full amount each time under a direct-pay arrangement between the payer and provider? It is the only and best way to bring transparency and control to the health plan member. This method also would not only eliminate needless administration and third-party involvement for medical practices, but also guarantee full payment at the time of service and actually increase revenue for providers who can instead focus on treating patients.


The beauty of direct payment is that it can apply a deeply discounted monthly membership (more on that in the next post) to all aspects of outpatient healthcare services, not just primary care. WoW Health, for example, has built a nationwide direct-pay network of more than 350,000 medical practices, as well as 2,100 laboratory sites, nearly 1,300 imaging centers, and more than 65,000 pharmacies. It covers both in-person visits and Telemedicine with 24/7 virtual urgent care and a nationwide Teletherapy network, the latter fitting in well with mental health visits given privacy concerns and the stigma still associated with seeking treatment for those conditions. Also included in this emerging model are dental and vision care with over 250,000 dental practices and 100,000 vision clinics.


In the end, direct pay can be used as a talent-management tool to help recruit and retain a better workforce during a time of unique labor challenges because we all know just how important healthcare benefits are to overall compensation.

Jawad Arshad, M.D., is CEO of WoW Health Solutions, LLC and Eric Silverman is founder and owner of Voluntary Disruption.

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