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Appalachia Health News tells the story of our health challenges and how we overcome them throughout the region. 

Alternative Services Help Doctors Keep Their Doors Open

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At the Turner Medical Spa in Cross Lanes, you can get vein treatments, chemical peels and Botox injections among a number of other aesthetic services. But the key word here is aesthetic – these are all optional cosmetic procedures and none of them are covered by insurance. In fact, the Turner Medical Spa doesn’t take insurance at all – it is a cash only practice.

“To be an entrepreneur is completely different than just doctoring,” said Doctor Samia Turner. She is the owner and operator of the medical spa. Her husband, Doctor Chad Turner recently opened a direct primary care office in the same building. He doesn’t take insurance either.

“The direction that healthcare has gone definitely lead him to a more concierge-type practice, trying to get away from the insurance headaches,” she said.


So what does Turner mean by insurance headaches? Well one doctor’s office could take hundreds of different insurance plans that all reimburse differently and have different requirements. Many doctor’s offices are finding they have to hire extra staff just to manage the billing and insurance negotiation.

But with the Turners’ model, “we don’t have to hire staff to do billing, we don’t have to pay for software for our electronic health record to do billing,” she said. “We have an electronic health record even though it doesn’t matter because we aren’t using insurance so we don’t get dinged if we don’t have an electronic health record.”

An electronic health record is the digital record of the care a patient receives in a doctor’s office. When Turner said “dinged” she meant penalized. Some insurance companies reduce the level of reimbursements to doctors who don’t use electronic records or use a system that hasn’t been approved by the company.

But since the Turners’ don’t rely on insurance reimbursements they are able to offer services for a lower cost than a doctor’s office that does have to pay for all these things. But back up, cash pay, concierge services are only for the rich right?

“People have had to change their health insurance for a higher deductibles,” she said. “They have to pay when they go to the doctor when they are sick anyway so they might as well pay a doctor that they like instead of sitting at MedExpress and paying 300 dollars. So those patients have found it more affordable than what they are doing otherwise.”

“Those patients” are people  who bought health insurance through the Affordable Care Act. Some have 5, 6, 10,000 dollar deductibles and the only way they are reasonably going to meet those is if they are hospitalized for a major illness.

The Turners are part of a small, but growing segment of the physician population that is experimenting with different ways to keep private practices open in the midst of difficult insurance requirements and reimbursement challenges, malpractice insurance, expensive electronic billing records, and crippling medical school debt.   

Some doctors like Elizabeth Brown  keep their regular practices open, but offer cash pay services on the side.

“Cash pay services, you see almost every private doctor doing that now,” said Brown. “You have to pay the bills. It’s sad, but the amount of your reimbursement is not enough to pay your overhead and pay your staff and keep up with my rising costs.”

Brown offers medical weight loss, Botox and other aesthetic procedures for cash paying patients. She estimated the cash services provide 20-25 percent of her overall revenue. For other offices, cash pay services are much more of a “side” thing.

Currently, though, up to a quarter of private practice physicians either offer or are considering offering similar services, according to the medical research company Accenture. It appears that in a world where the number of doctors in private practice have dropped 50 percent in 15 years, reimagining the model is the only way to stay open.  

*Editor's Note 8/18/2016: MedExpress offers a self-pay option for patients who do not have, or choose not to use, health insurance.  This self-pay fee is $119. 8/22/2016 Dr. Turner has since clarified her use of the word MedExpress. She meant is as a generic statement about urgent care vs. direct primary care, not about MedExpress specifically.

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