A doctor speaks on the telephone.
America is one of the only developed countries that doesn't have a universal healthcare system for its citizens. This means that every year, people have to apply for healthcare through their employer or the Affordable Care Act (ACA) if they'd like insurance. Seeing a doctor can be costly, even with health insurance, which is why many people rely on their coverage to reduce their out-of-pocket expenses.
Dr. Ashlee Hendry, a family medicine doctor, is revealing that insurance may not always be the most cost-effective option. Hendry is the CEO of the medical practice Mid-South Direct Primary Care. She spends her time on social media educating the public about direct primary care services and self-pay rates for procedures. With millions of Americans facing skyrocketing premiums, many are looking for ways to continue getting healthcare if they have to let their insurance policies lapse.
Doctor on call, ready to assist patients remotely.Photo credit: Canva
Hendry's private medical practice is a Direct Primary Care (DPC) office, which means the practice does not accept health insurance. This cuts out the middleman for many people who may not be eligible for health insurance, can't afford it, or simply don't want it. Instead of health insurance, DPC medical practices offer plans that you pay for monthly, which include preventative care visits and chronic health management.
Barring a catastrophic event, Hendry's videos are proving that lack of health insurance doesn't mean lack of quality care if you know what you're looking for.
A common high-cost health item is having a hospital birth. The average cost for an uncomplicated vaginal birth in America ranges from just under $9,000 to a little more than $26,000, depending on the state. These prices are before insurance kicks in, according to CBS News.
Hendry's practice is in Mississippi, and the average cost for an uncomplicated vaginal birth is $12,413, according to the same CBS News report. But when the family doctor called around to hospitals asking for the self-pay rates, the price difference was jaw-dropping. The very first hospital she called was more than $5,000 cheaper, and it included all of the prenatal visits, monitoring, and testing.
"If they're self-pay, they give them a package price, which would include the delivery and all of the services that they might need during the nine-month period," a woman on the phone says before Hendry requests the total. "$5,730.37, and this for a routine vaginal delivery with pre- and post-care in the hospital." The woman further explains that this includes the price of an epidural, and it can be put on a payment plan.
When pressed on the normal price without the self-pay discount, the woman on the other end of the phone said that what they charge depends on the insurance. When inquiring about a cesarean delivery, Hendry was informed that the package cost would be $7,574 for self-pay patients, while the average cost charged to insurance is $26,280, according to UW Health. Depending on the insurance, the out-of-pocket fee could be much less than the self-pay rate. But when considering the overall fee for monthly premiums, copayments, and coinsurance, some individuals may feel the self-pay rate is cheaper.
The doctor didn't stop at finding out how much a hospital delivery would cost a patient. In a video just a few days prior, she called around to see how much an MRI without contrast on someone's back would be. The prices varied wildly depending on where she called, but one office blew her mind with how low their rate was.
"You wanted to know an MRI lumbar spine without, correct?" a woman's voice says from the phone. "Alright, so the self-pay price they can pay on and then pay on monthly is $1,791, or they can do a self-pay discount price of $209.05, but that does have to be paid the day of the scan."
"Wait, two...two hundred and nine?" Hendry asks in disbelief. But the woman on the phone confirms that she did in fact say $209.05, explaining that in order to get that discount, the patient has to pay that price up front.
People are flabbergasted, wondering whether insurance companies have been scamming them their entire lives or whether hospitals have been scamming insurance companies and passing the costs on to consumers.
One person writes, "It should be illegal for them to inflate the bills for insurance companies."
Another says, "At this point I think people may be better off without any insurance."
Someone else laments, "Our Healthcare system is a pyramid scheme."
One commenter is outraged by the MRI prices, saying, "Brooooo I paid $800 AFTER insurance. wtf."
"The one call saying 'TRUE self pay patient, they don’t have ins.' We are being punished for having insurance!" another surmises.