No Insurance, No Problem! How One Doctor is Changing the Payment Model

Studies show around 25% of Americans skip going to the doctor even when it’s medically necessary due to the high cost of care. Insurance, copays, premiums, and endless paperwork can be a challenge for both patients and providers.

That’s why Voyage Direct Primary Care in the small town of American Fork, Utah is taking a different approach. Patients don’t need insurance to go to the doctor. They get unlimited access to their primary care provider for one low price, paid monthly or annually.

As it turns out, patients and providers couldn’t be happier with the results.

Saying Goodbye to Insurance

Dr. John Sanders, D.O. at Voyage Direct Primary Care, says he first got into medicine to help people, but the reality of working as a doctor in rural America was a huge wake-up call.

“American healthcare is broken in many ways,” he says. “Having worked as a family physician in the system for more than a decade, I’ve become acutely aware of the multitude of pain-points prevalent to both patients and physicians. I have served on multiple hospital committees and have headed a multi-specialty clinic in both rural and urban settings. I’ve attended meeting after meeting trying to innovate, to fix problems for physicians, clinics, hospitals and, most importantly, provide better care for patients.”

But he felt that he wasn’t getting anywhere. Trying to get paid as a doctor always meant dealing with several third parties and corporations.

“Physicians are overloaded with paperwork, claim rejections, insurance refusals, prior authorizations, box-checking and other bureaucratic hoop-jumping that sucks time away from actually delivering care. Most American families are medically underserved. The pain points of the system condition them to avoid doctor visits and the physicians fight a losing battle trying to deliver the care these families deserve,” Sanders added.

That’s what convinced him and his colleagues to abandon the insurance payment model.

He remembers working at the clinic talking to a mother whose son came in with hot, swollen joints all over his body. She told him that he had been sick for weeks but that she hadn’t taken him to the doctor for fear of being turned away.

“During her previous experiences with similar symptoms, she’d taken her son to urgent care, paid a $75 dollar co-pay, spent five minutes with a physician’s assistant, and was told to go home and take Mucinex,” Sanders said.

Her daughter later tested positive for strep, which led her to believe her son was also suffering from an infection, even though the doctors failed to catch it. Sanders says strep can be treated for as little as $10, but because the mother waited, her son was facing a severe case of post-streptococcal arthritis. He then had to coordinate with several specialists and diagnostic professionals to save her son before the disease could permanently damage his body.

Monthly or Yearly Dues

Voyage Direct Primary Care is trying to do away with these kinds of administrative headaches and cost concerns for patients. Adults get unlimited access to their PCP for just $79 a month. If their parents subscribe, children can be added for just $15 more a month. Adults over the age of 56 get all the care they need for $89 a month.

The clinic performs a range of essential services, including family medicine, pediatrics, osteopathy, orthopedics, women’s health, neurology, endocrinology, and more. Patients of the clinic also get discounts on labs, medications, x-rays, MRIs, CT scans and pathology, thanks to a pre-existing agreement between Voyage DPC and its partners.

Under the new model, patients know exactly how much they’re going to have to pay before they even walk in the door. In most cases, they don’t even see a bill. The monthly fee is just deducted from their account at the end of the month.

Sanders says this gives him more time to focus on patients. He says that many practices will only schedule patients in 10–15-minute intervals, which barely leaves enough time for the provider to go over the person’s electronic health record.

“During office visits, we spend 30-60 minutes with our clients emphasizing high-touch, high-quality healthcare while developing lasting relationships with our families,” Sanders said. “We will even do an occasional house call to our families. It’s truly like healthcare used to be.”

For now, everyone in the area seems to be in love with the new model. Patients and families spend more time focusing on their care and meeting regularly with their doctor instead of worrying about their finances. Doctors also have more freedom to run their practices as they see fit without worrying about whether they will be reimbursed for their services.

It’s not clear if this model can be replicated across the country. Some facilities may not be able to survive on monthly or annual fees alone, but Voyage DPC is showing providers there’s another way.