I heard whispers of Atlas Direct for a couple of years. It really seemed promising and the other day Josh gave me a heads up that it was being released. This is not a sponsored post nor am I working for AtlasMD. I just thought this is interesting enough to share with you all. Note: you cannot use Atlas Direct as a patient unless you have a DPC doc, which does not have to be an Atlas.MD user.

This product is different:

Atlas Direct pays predetermined cash amounts directly to you whenever covered medical events occur.

This “fixed indemnity” payment model has several notable features:

• There are no deductibles or copays
• Payments go directly to you, not providers
• Cash benefits can be used for any expense, not just medical bills
• There are no open enrollment periods, so you can enroll at any time
• There are no network restrictions
• Payments can be used to supplement other insurance coverage

So, let’s say you have an ER visit. You negotiate with the hospital for a cash price. Atlas pays you ($1500) no matter what you negotiated even if it is less.

The goal of this product is for Atlas Direct to help to cover some of the bigger stuff like “emergency room, hospitalization, surgeries, maternity care”. The cost is really affordable. $445 or less per month for a family of four with two children under 20 and two adults under 40.

What does Atlas Direct cover?

Atlas Direct is an insurance policy that combines straightforward cash benefits for hospital stays with specific cash benefits for ER visits, ambulance transportation, over 400 surgeries, and several other medical procedures and services, such as childbirth, skilled nursing care, and outpatient radiation or chemotherapy.

Atlas Direct pays predetermined dollar amounts directly to covered persons—but only for the limited set of benefits summarized below and always as defined in the Atlas Direct policy documents, which may vary from state to state. 

Critical Medical Services Benefits

• $1,500 per hospital admission, max. 2 admissions per year
• $3,700 per day for inpatient hospitalization, max. 26 days per year
• $5,200 per day for intensive care, max. 18 days per year
• $1,500 per ground or water ambulance, max. 1 per year
• $5,000 per air ambulance, max. 1 per year
• $1,500 per day for Emergency Room care, max. 1 per year

Maternity Benefits 

• $5,000 per vaginal delivery, max. 1 per year
• $8,000 per cesarean delivery, max. 1 per year

Surgical and Medical Procedures Benefits

• $1,500 to $30,500 for 439 common surgeries and medical procedures, max. 10 per year

Examples include: 

• $1,500 for colonoscopy with biopsy  
• $3,500 for strabismus correction 
• $6,500 for laparoscopic hernia repair
• $9,500 for rotator cuff repair
• $11,500 for open uterine fibroid tumor removal
• $15,500 for total hysterectomy
• $16,500 for coronary stent placement
• $18,500 for radical bilateral mastectomy
• $27,500 for catheter closure of atrial septal defect
• $22,500 for laparoscopic prostatectomy
• $30,500 for the creation of a cerebral shunt

Our Additional Benefits

• $750 per day for outpatient radiation or chemotherapy, max. 40 days per year
• $300 per day for skilled nursing care, max. 30 days per year
• $300 per day for hospice care, max. 60 days per year

Finally, please note that the above benefits are subject to a cumulative annual maximum of $100,000 per person for covered claims, meaning that covered claims will be paid until the cumulative amount paid in claims for the year reaches $100,000 per covered person. After $100,000 has been reached, no further claims payments will be made.   

It is also important to understand that Atlas Direct does not include Direct Primary Care, which you have to obtain from a Direct Primary Care provider who will charge you separately for their services. 

Finally, please understand that Atlas Direct is not a comprehensive major medical plan and that if you are looking for comprehensive health insurance you should consult with a licensed insurance agent or visit your state’s health insurance marketplace.

For additional details about Atlas Direct’s benefits, eligibility, limitations, and exclusions, please see our brochure. For a list of the 439 surgeries and medical procedures covered by Atlas Direct, click here. 

There are no deductibles or copays.

The one thing that Atlas Direct is pushing is their service. I think they will excel at that. They will have real people answering your questions in real time which is much needed for this. But this is so new and radical that they 100% need this service to answer questions.

Atlas Direct is NOT available everywhere, only 13 states plus DC:

• Alabama
• Arizona
• Connecticut
• DC
• Georgia
• Hawaii
• Iowa
• Massachusetts
• Michigan
• Nebraska
• New Jersey
• Rhode Island
• Tennesee
• Wisconsin
• Washington, DC

Here is the warning statement on the site which I think needs more explanation:

The insurance policy advertised on this website offers limited health benefit coverage and is a supplement to, rather than a replacement for, comprehensive major medical insurance coverage. It is designed to provide benefits at preselected, fixed dollar amounts for covered diagnoses. This limited benefit coverage does not satisfy the minimum essential coverage requirements of the Affordable Care Act. Coverage is not available to insureds age 65 or over.

Okay, so no one over 65 can use it. Does the ACA issue mean anything anymore?

And they are calling it supplemental coverage I guess like AFLAC but that may be for legal reasons. It really seems that it is meant to be used by itself.

Here are some questions you may have:

• What if the hospital charges more than their defined benefits that Atlas Direct offers?
• What if you hit the $100K max on something? Are there any options?
• Is this truly meant to be used by itself?
• Some of the prices for events seem low. What if the hospital doesn’t negotiate?
• How should you negotiate with the hospital for pricing?
• Atlas Direct pays a set price for each event. If you have other insurance, do you still get paid that amount even if the other insurance paid the hospital?

Please respond ON THIS SITE with questions and we can see if Josh will answer.

Until then, all there info is on their site. The details are below in their PDF.