Cost Comparisons

Examples

1) Johnny is 10 years old and was sliding into second base and suffered a gash to his right knee. It is bleeding quite a bit. It is 8:00 at night and he is at Harrel Ferrel Park.

Option 1: Johnny’s parents take him to the ER where they wait 2.5 hours. The doctor places 5 stitches, and they leave 15 minutes later. The bill is $1200. They then return 10 days later to an insurance based practice and are charged $165 for the stitches to be removed.

Option 2: Johnny’s parents take him to the Urgent Care. The wait is only 45 minutes. The doctor places 5 stitches, and they leave 15 minutes later. The bill is $325. They then return to the Urgent Care and the stitches are removed for free.

Option 3: Johnny’s parents call Dr. Riggs’ cell phone. They meet her at Direct Medical Care clinic 10 minutes later. Dr. Riggs places 5 stitches, and 15 minutes later they pay their member price of $200. They then return 10 days later for stitch removal which is free.

2) Cheryl is 55 years old and has been suffering for 10 days from a horrible cough, chills, aches, and some shortness of breath. Her co-workers are very concerned when she struggles to carry on a normal conversation. She is pale and clammy.

Option 1: Her co-worker calls for an ambulance. In the ER she has a full cardiac work-up and is discharged 5 hours later with a diagnosis of acute bronchitis. Ambulance bill is $1200. ER bill is $3278.

Option 2: Her co-worker drives her to a traditional insurance based practice. They fortunately have time to evaluate her, and she is diagnosed with acute bronchitis with no extra testing. She is billed $170. She hasn’t met her deductible and is responsible for her insurance negotiated price of $120 with her copay. Her $30 copay doesn’t go towards her deductible nor her maximum out of pocket for the year.

Option 3: Her co-worker drives her in less than 5 minutes to Direct Medical Care, she is seen right away, and diagnosed with acute bronchitis. Cheryl has no copay and since Cheryl is a member the visit is FREE. Cheryl already paid for her 1 year membership in a lump sum from her HSA of $800. That fee she paid was applied toward both her deductible and her out of pocket maximum for the year.

3) Charles is 72 years old and developed an atypical headache 3 days ago. Charles is well known to Dr. Riggs.  His medical history combined with his odd behaviors on exam are very concerning to her.  She orders some basic labs and would like to order an MRI of his brain.  Charles has Medicare.  Dr. Riggs has opted out of Medicare.  She has a private contract with Charles in which neither she nor Charles can bill Medicare for her services.  However, Dr. Riggs is still enrolled in Medicare which means that Medicare should cover the MRI that she refers him to get done.  She has a lengthy discussion with Charles about her concerns and the need to pursue an MRI of his brain.

Option 1: Charles wants to use his Medicare to cover the MRI. Dr. Riggs' nurse tries to get a prior authorization for the MRI of the brain but it is denied.  Medicare insists that Charles be seen by a neurologist first. Dr. Riggs' nurse calls the neurologist's office and they don't have any openings for 3 months. Charles decides to take the chance that it isn't a tumor. He dies in his sleep 1 week before his appointment with the neurologist.

Option 2: Charles trusts Dr. Riggs and would rather just pay out of pocket at Direct Medical Care's negotiated discounted rate of $420 rather than wait on the specialist. He proceeds to the imaging center and has the MRI done. Unfortunately a tumor is discovered. He is referred to a neurosurgeon and neurooncologist and undergoes successful treatment. At 75 years of age Charles is in remission and is able to see his oldest granddaughter get married.