I recall a visit from my insurance-based care days when I was seeing an elderly patient for her Medicare annual wellness visit. We were going through her preventive care, and then she started to say, “You know Doc, I’ve been having this… you know what, never mind. I won’t bring it up because I don’t want to be billed. This is my free visit.”

I coaxed her a bit to get her to share her concern with me, but she refused. After that, I just stopped asking and proceeded with her preventive visit. She and I both knew that if she brought up a problem, her visit would be billed as a problem visit, in addition to her preventive visit, and she would face an additional fee.

Sure, I don’t have to add a code for a problem visit. However, if I address a problem, and I don’t bill for it, I could be investigated for insurance fraud.

Many physicians are generally rule followers. We have had to follow so many rules to even get to where we are, so the thought of breaking the rules, even if they are unethical, is a hard pill to swallow.

There are so many lost opportunities in primary care because patients are afraid to speak up to avoid surprise billing. In many ways, it is the smartest thing that they can do, as the number one cause of bankruptcy is medical debt. There were so many times when physicians trying to help patients only caused them significant financial harm. This is disgraceful.

In primary care, what makes us so spectacular is our ability to practice preventive medicine. Whatever that patient wanted to tell me that day, could have been the difference between solving a small problem now versus a major problem later. However, the rules of insurance imposed a gag order during her medical visit.

When I decided to become a direct primary care physician, I was so worried about abandoning patients who relied on insurance for their medical care. Now, I realize more every day, that the intervention of insurance is detrimental to the beauty of the primary care relationship. I can’t continue to be a rule follower if the rules are hurting my patients.

I could no longer be complicit in doing the dirty work for the insurance companies. My patients need to be free to discuss their care with me without fear of surprise billing. This is how we prevent catastrophe and we ultimately save money. 

Every physician knows that the most important part of patient care is the patient history. How can we be exceptional physicians when insurance blocks our ability to know our patient history?

The answer is clear. Insurance-based care harms patients.

It’s past time for Direct Primary Care.