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The Doctor Will See You but Not Your Insurance

Direct primary care physicians expect to be paid by you — directly

Who's involved?

An estimated 5,000 doctors in half of the states have already adopted this model — and as the name implies, most are primary care physicians (sometimes known as general practitioners), the frontline caregivers who handle an estimated 85 percent of the most common conditions.

Chase, who runs a software company that makes electronic forms for doctors and patients, predicts that 16 percent of primary care physicians will adopt a no-insurance model in coming years, with expected growth among cardiologists, pediatricians and more outpatient surgery centers.

Can I see this type of physician if I'm on Medicare or Medicaid?

Usually, no. These doctors opt out of all insurance — including Medicare and Medicaid. However, some practices provide special rates for Medicare patients.

In 2011, U.S. Rep. Bill Cassidy (R-La.) introduced a bill to allow beneficiaries to use these physicians by paying their monthly fees ($100 for Medicare recipients and $125 for those on Medicaid). Despite garnering some bipartisan cosponsors, H.R. 3315 has gone nowhere thus far.

What are the pros and cons for patients?

Pros: The most cited advantages: more and better quality time with doctors — and no insurance red tape, on either end.

"For years, my care was impersonal, inconvenient," says Bryan Welch, 54, who switched to Neuhofel on the advice of his daughter, a medical school student. "And now, I see my doctor when I want, for as long as I want, and we both can be as efficient as possible as we take care of my health."

Cons: Because participants are usually primary care physicians, patients are urged to get catastrophic or other medical insurance for severe health problems and hospitalizations. Also, although monthly memberships are comparable to some insurance co-pays, the bottom line cost may be higher for those who see a doctor only occasionally.

How do I find a physician who does direct primary care?

That's another con: Unless cash-only doctors get media attention — and most don't — it's largely through word-of-mouth. A small, incomplete listing of physician participants is at dpcare.org/practices, and some may be found through the American Academy of Private Physicians, but most of its members are more expensive concierge doctors.

Sid Kirchheimer is the author of Scam-Proof Your Life, published by AARP Books/Sterling.

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