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Out-of-pocket expenses For Insurance Based Primary Care in the USA

Out-of-pocket expenses for insurance based primary care in the USA can vary widely. So often however these are significantly higher than patients know up front or expect. Here are the most common patients with health insurance driven primary care encounter.





  1. Deductibles: Many health insurance plans have deductibles, which are the amounts individuals must pay out of pocket before the insurance coverage kicks in. For primary care services, patients may need to pay the full cost until they meet their deductible. Unfortunately for many families this sometimes prohibits patient access to care.

  2. Copayments: A copayment is a fixed amount that a patient pays for a covered healthcare service, and it is typically due at the time of the visit. For primary care visits, a copayment may be required, and the amount can vary based on the insurance plan. The newest thing patients are experiencing are add-on fees that they don't expect or were never told about.

  3. Coinsurance: Instead of or in addition to copayments, some insurance plans require patients to pay a percentage of the total cost of the service. This is known as coinsurance. This is where patients need to be especially concerned about when unexpected care such as emergency room visits and urgent care . Primary care services may be subject to coinsurance, and the patient would be responsible for the specified percentage.

  4. Non-Covered Visits: Some visits may not be covered by insurance, and patients would need to pay for these services entirely out of pocket. It's essential for patients to be aware of their insurance coverage and any exclusions.

  5. In-Network vs. Out-of-Network Costs: Costs can vary depending on whether the healthcare provider is in-network or out-of-network. In-network providers In many parts of the country are not available in a timely manner for so many patient care needs.

  6. Annual Check-ups and Preventive Services: Some insurance plans may cover annual check-ups and preventive services at no cost to the patient. In fact it's extremely rare to find any real true preventive primary care especially regarding lifestyle, the impact of our daily routines and tools that patients really can use that's covered. However, it's important for individuals to check their specific plan details to understand what is covered. Oftentimes when patients add these up over the course of a year, especially with the family they are shocked. In our practice you have access to spinal manipulation, supportive therapies, lifestyle medicine, nutrition counseling, dietary & weight loss planning and a whole bunch of other tools and systems unavailable in a typical primary care practice all included in our Plus Plan rolled in together at one low fee. Just $6.47/day. Your HSA, FSA or employer may actually cover this as well! No where else can you find all this care together and readily available for one monthly fee? Nowhere.

Think about it. Questions, concerns just reach out and we will gladly set up a time we can meet and talk. If you know you're ready to enroll in our Direct Primary Care practice while spaces are still open just go HERE

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