The Alabama Physicians and Dentists Direct Pay Act.

Dr. Chad Williamson last year opened his direct-pay clinic. He has 300 patients who pay $60 per month per individual or $100 per couple. Children are $10 a month. He doesn’t accept insurance, though he said about half his patients do have it…………..

Officials: No-insurance physician payment practices could expand state health care access

By Mary Sell Montgomery Bureau

Jun 19, 2017

 

MONTGOMERY — In the three years since Kimberly Samuel opened her health clinic in Decatur, she has seen 2,000 patients. Unlike most medical practices, Samuel doesn’t accept insurance.

Instead, her patients — or in some cases, their employers — pay a monthly fee for primary care visits in Samuel’s concierge-style practice, A Heartbeat Away. A scheduled visit typically lasts 45 minutes, and patients can reach her 24/7 by phone or text, she said.

Sen. Arthur Orr, R-Decatur, sees the need for more physicians willing to accept payment directly from patients and save them high insurance premiums.

In the legislative session that ended last month, lawmakers approved Orr’s Senate Bill 92, the Alabama Physicians and Dentists Direct Pay Act. It lays out some ground rules for direct payments and specifies that agreements between patients and providers can’t be regulated like insurance.

“My hope, and we did a lot of checking in other states, is that it would benefit that level of the population that is employed, but cannot afford regular, routine family coverage that could cost over $1,000 a month,” Orr said. “It could help them and employers who want to provide some sort of benefit to their employees.”

In Fort Payne, Dr. Chad Williamson last year opened his direct-pay clinic. He has 300 patients who pay $60 per month per individual or $100 per couple. Children are $10 a month. He doesn’t accept insurance, though he said about half his patients do have it.

“Insurance does not equate to good medical care,” Williamson said last week. Many of his insured patients came to him with diabetes or hypertension and weren’t getting quality treatment or time with their insurance-paid providers, he said.

Meanwhile, his overhead is significantly lower without the staff needed to file or adjust insurance claims, he said.

Samuel said some of her patients have found it cheaper to pay her monthly fee — an individual is $50 a month, plus a $15 per visit co-pay — and be fined under the Affordable Care Act for not having health insurance than to pay for traditional insurance.

Williamson and others encourage people to have catastrophic insurance coverage for illnesses or events beyond the scope of a primary care provider.

Williamson and Samuel both said they think direct pay could work well for those whose health care is covered by Medicaid or Medicare.

“Access is our problem — we’ve restricted access (to health care),” Williamson said.

The Medical Association of the State of Alabama is a proponent of the direct-pay model because it could attract more physicians to rural Alabama and help the uninsured or those with high-deductible insurance plans.

“In other states, direct pay has also proven to help employers struggling with increasing premiums to continue to provide health care to their employees,” said Lori Quiller, director of communications for the association. “While direct pay cannot entirely replace health insurance, for many Alabamians a direct pay agreement with a physician could mean the difference between having access to quality, affordable care or not having access to any care at all.”

Koko Mackin, a spokesperson for Blue Cross and Blue Shield of Alabama, said the largest insurance provider in the state encourages its members to make the best coverage decisions for their needs.

“We also respect and support the choices made by health care professionals on their participation in Blue Cross’ preferred provider networks or similar networks for other insurers,” Mackin said. “… While we respect that choice, providers who opt to practice under the direct care format will not qualify to be included in Blue Cross’ network of preferred physicians or dentists.”

She also said while direct care may be appropriate for some, people should fully understand what is provided and what type of care is not included.

Samuel and Williamson are among the few in Alabama currently accepting direct payment from patients, but Samuel said the method should be expanded.

“What I do works,” she said. “There is no reason we couldn’t implement it around the state for the people who can’t afford insurance.”

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mary.sell@decaturdaily.com. Twitter @DD_MarySell.

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