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What are the consequences of rejecting insurance payment?

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Direct care practices operate just as their name implies – they provide care directly to their patients, eliminating the insurance middleman. Direct care physicians focus on preventative care, with a goal of maintaining their patients’ health and well being to help prevent major illnesses and injuries. By reducing the need to secure prior approval and then insurance reimbursement, direct care physicians are better able to focus on the needs of their patients without the administrative overhead.

Rob Lamberts, MD, a board-certified internist and pediatrician with a direct primary care practice in Augusta, Georgia, writes in Medical Economics that one result of the direct care practice eliminating the insurance payments is an increased focus on reducing the cost of care. With healthcare costs rising, that can be a significant factor for independent physicians as well as for their patients.

Dr. Lamberts, who takes advantage of the benefits of Elation Health’s electronic health record (EHR) solution, notes that there are three key benefits to rejecting insurance payments:

There is an increased focus on customer service. Direct care patients enjoy more time with the physician during each visit. The wait to see the physician is often reduced significantly as well. When the direct care physician is more focused on patient care and less on insurance paperwork, the physician also becomes more accessible before and after the visit. Dr. Lamberts notes that some patient care can actually be “done via text message or phone, reducing the need for coming to the office at all.”

Patient records are freed from the coding nightmare. As Dr. Lamberts states, “Most health records hide important clinical information in an avalanche of insurance documentation compliance.” The direct care physician is able to “document for care” without the need to apply codes and secure insurance approval.

Patients trust their doctor more. Direct care physicians who reject insurance payments are winning back the confidence of their patients who “are increasingly suspicious of the motivations of their physicians, wondering if the care they get is focused on them or if it is done for increasing revenue or following insurance company rules.”