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Top 6 problems in Insurance-based Healthcare and how DPC helps solve them

Updated: May 22, 2023

Every year, more Americans are looking for new ways to manage their healthcare. While Health Insurance remains one of the most common options, its drawbacks have increased in recent years. Although Insurance can be helpful in catastrophic events, many people are now turning to Direct Primary Care (DPC) for their day-to-day healthcare needs.


Whether you have insurance or are searching for coverage, you may know the difficulty of understanding all the perks of the Insurance system. Insurance policies can be challenging for people to navigate, and understanding their drawbacks in certain situations can save you time and money. Let's explore the Top 6 Problems in Insurance-based Healthcare and how DPC helps solves them.

Insurance policies are difficult to understand


High out-of-pocket costs


Many patients are frustrated with the high costs associated with visiting their Primary Care Doctor through their Insurance plan. Even though thye are paying their premiums, most insured people still have to pay additional out-of-pocket fees including copays and meet deductibles to access health services. The problem gets worse when patients need lab tests or imaging studies, as they often have to pay much higher prices than self-paying patients.

Medical expenses

Direct Primary Care services offer an alternative solution, as patients can enjoy unlimited access to their doctor for a monthly fee that is about the price of their cell phone bill. Additionally, patients gain access to significant discounts on labs, pharmacies, and specialist referrals. Often times the preventative labs they gain access to through their DPC doctor are not covered through Traditional-Insurance plans and they would have to pay an inflated rate for these tests. When patients don't understand when to use their insurance vs paying out of pocket/ using their DPC doctor for care, they may wind up paying much more for services. In DPC, you are often paying much less for much more.


Limited coverage and confusing insurance policies


Some patients may find that their Insurance plans are not transparent about what is covered, leaving them with unexpected expenses. Insurance policies also tend to be complex and confusing, making people end up choosing plans that do not fit their needs.


In contrast, Direct Primary Care policies are straightforward and transparent. Any additional fees for lab testing or procedures are fully transparent with the goal of helping people save money. You can be assured that there will be no surprises on your bill!


Long wait times and short visits


The average wait time for an appointment is at an all-time-high of 25 days and it's expected to rise further in the coming years, according to recent surveys. In addition, the average visit duration is at 8 minutes. This is mainly due to the fact that doctors in insurance-based practices often have 2,000 - 3,000 patients per doctor, forcing them to see 26-32 patients per day to accommodate everyone.

People waiting in a crowded doctor's office

Insurance companies place many pressures on doctors through administrative burdens and limitations on their ability to make decisions in the best interest of their patients. As a result, practices are spending more time on bureaucracy fighting with the insurance companies to get necessary medications, tests, and procedures approved rather than patient care.


Fortunately, this is not a concern in Direct Primary Care practices. In most DPC practices, doctors have only 10-25% of the patient load of traditional practices. This means that patients can get same-day or next-day appointments, and consultations are typically three to six times longer than those in traditional practices, ranging from 30 to 60 minutes.


Limited choices.


Many patients face obstacles when it comes to accessing Primary Care Doctors, particularly in rural or underserved areas, or due to restrictions within their insurance policies. These limitations can leave patients feeling like they have limited options for receiving the care they need.


However, Direct Primary Care memberships offer patients greater flexibility and choice in their healthcare options. With DPC, patients can select the services they receive, when they receive them, and may also access new options and discounts through their primary care doctor.


Administrative issues


Bureaucratic issues such as billing errors and delayed claims can be frustrating for both patients and doctors. Dealing with administrative tasks can consume more time than actually receiving care.

Administrative burden

With a Direct Primary Care membership, most administrative processes are handled by the practice. Additionally, if any issues arise, the practice is easily accessible and will address concerns and provide personal assistance.


Inadequate communication


Communication problems between patients and doctors can lead to misunderstandings and ineffective treatment. Insurance-based healthcare may not provide the necessary communication channels for patients to discuss their concerns or ask questions, leaving them feeling disconnected from their doctor. This can happen in both traditional insurance-based primary care and specialty care.


Direct Primary Care practices prioritize communication between patients and doctors. Lower patient loads allow DPC doctors to have more time to listen to their patients and answer their questions, building a stronger relationship with them. Often times, because of the increase in visit time and ability to listen more, DPC doctors are able to prevent unnecessary referrals to specialists which increases patient satisfaction, peace of mind, and lowers costs. DPC allows for more personalized care and improved health outcomes.


Doctor taking good care of his patient

Direct Primary Care can solve many of the persistent problems of insurance-based healthcare. Transparent policies, unlimited access to doctors, shorter wait times, more personalized care, and better communication channels, makes patients experience a higher quality of healthcare at a lower cost. Direct Primary Care might be the right choice for those who are looking for an improved personalized, quality, and convenient healthcare experience than the traditional model. In our next issue, we will show you how DPC can also save you money compared to insurance-based Healthcare.

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