Renown and Anthem Blue Cross Blue Shield negotiations nearly leave many Reno residents without a doctor.

renown bcbs doctors turning backs on patients

Photo by Luis Melendez on Unsplash

In Reno, there are very few choices when it comes to healthcare. One of the largest healthcare systems in Northern Nevada is Renown. With the recent news that Renown Healthcare was possibly going to stop accepting Anthem Blue Cross (BCBS) insurance effective August 1st, 2019, many were faced with the possibility that they may “lose” their doctor. This is disheartening and certainly provoked anger and/or anxiety. However, this also sheds light on the deeper issues that exist within the insurance-driven U.S. healthcare system.

Americans have come to believe that health insurance equals health care. This is simply not always the case. Insurance and/or coverage implies that should you as the healthcare consumer meet certain criteria, often based on their own guidelines, you may or may not have your care covered. Not to mention, that you have to pay up your part of the deal, the “deductible” before they pay for their part of the deal. Health insurers have gradually taken over every facet of healthcare, arguably to the point of “practicing medicine”, undermining physician and allied health professionals’ better judgment. What was at first only relevant to high-dollar hospital or specialty care, third-party payer red tape has now bled into the front lines of care…the primary care office.

Who hasn’t been subject to a disruptive prior authorization, or a medication switch, or frank denial of care due to a health insurers policy or procedure in the name of “quality of care”, when clearly there was an underlying financial motivation on the insurers part?  It is this financial incentive that is most apparent when negotiations fall apart, and no agreement is made between the health insurer and a health system (doctors, hospitals, clinics, etc.) such as what almost happened with Renown and Anthem BCBS. 

Direct Primary Care: health care without insurance red-tape.

What would happen if one removed health insurance from the equation? Oh, the horror, right? Well, not necessarily. Insurance-based doctors are under the gun to see a high volume of patients, all while documenting everything more so to get optimally paid by third-party insurance than to simply write down the pertinent history, physical exam, assessment, and plan. Doctors would rather not have to deal with insurance, however, insurers bring them patients and therefore easy revenue. Narrow networks, managed care, accountable care, and value-based care are all buzz words that didn’t exist many years ago when the overall costs (or more accurately, “charges”) of healthcare were much less. Rather, many people paid for their doctor visits on their own. Doctors were happy and patients were well taken care of. No third party hassles.

Fortunately, there has been a movement in the primary care space called direct primary care (DPC), which is a membership model of care whereby patients pay monthly or annually for a private physician. Since there is no insurance billing in a DPC practice, all care is driven by the doctor-patient relationship. No co-pays, extended visits, enhanced technology-driven access, home visits, discount labs, and in-office pharmacy are just some of the included benefits for patient “members” in a DPC practice. Often DPC fills the gap in today’s high-deductible health insurance landscape. Some people drop traditional health insurance altogether in favor of a health cost sharing plan like Liberty, Christian Healthcare Ministries, or Sedera, just to name a few. For plans as low as $150/mo one can carry catastrophic coverage for a low $500 “deductible” (technically called an initial unshared amount). Combining the concierge-like care of a DPC practice and a health share plan provides the ultimate in patient-centered, value-based healthcare. 

Reno now has a direct primary care practice, Preferred Family Medicine, started by experienced family physician Christopher C. Highley D.O. When it comes to choosing one’s healthcare coverage, it is good to know all of the options, beyond the usual commissioned broker-recommended offerings.

Concierge direct primary care brings value to different people in different ways. At a minimum, the direct access at any time to a doctor beats waiting for days to weeks to see a doctor. For others, the all-inclusive primary care benefits including acute/chronic care, on-site lab draws and pharmacy, minor procedures, comprehensive wellness, and telemedicine for a simple monthly or annual fee is appealing. And for some, just having a doctor who is willing to spend however long it takes, even if it’s 90 minutes, with them to make sure all of their concerns are addressed thoroughly, justifies retaining a private physician. 

Whether you have Anthem Blue Cross Blue Shield, Medicare, a health share, a high-deductible health plan, or no insurance, consider becoming a member of Preferred Family Medicine where your primary care needs will not only be met, but your expectations will be exceeded. Book a meet and greet today to see if DPC is the right fit for you.