How Insurance Affects Health Care Pricing
Updated: Apr 7, 2022
We've been getting a lot of questions about how our no-insurance model of care can be affordable. Just how does insurance work anyway? Many people believe that, if you are covered by insurance and have a primary caregiver that is "in network", you're saving money.
That isn't always the case. Traditional clinics contract with insurance companies. Essentially, they create a business partnership. Clinics gain the ability to direct bill insurance and obtain direct payment. In return for this easy billing and guaranteed payment, clinics must agree to charge ALL of their patients, insured or not, the same, grossly inflated insurance mandated price model.
Depending on your deductible, you can pay out of pocket for 4 or 5 office visits at $250 each before ever having insurance step in and help cover the costs. For instance, there is a Blue Cross/Blue Shield plan that covers office visits, but requires a $50 copay for each visit. At Louisville Medical Center, we only charge $40 for an office visit and your health information is NOT shared to a third party.
Further, when you go to a clinic that accepts insurance, you generally have no idea what the prices of visits, testing or procedures are. You don't get to do any price comparisons and it stops you from being a savvy consumer of the services provided.
At Louisville Medical Center, our pricing menu is prominently published on our web site so you can very clearly see what investment you will make in your health. This allows you to be a partner in your health care and YOU decide how you want to direct your care. Many times, your insurance company gets to decide what care you are eligible to receive. We believe those important, private decisions should be made by you in partnership with your health care provider and not by a faceless corporation that is focusing on cost saving and the bottom line for investors.
Even though we don't accept insurance for in-office visits and procedures, you can still submit your printed paid invoice for our services to your insurance company for reimbursement, if you are eligible. Blood tests and certain other laboratory testing we cannot do in-house are sent out to an independent laboratory which DOES bill insurance as well.
Third Party Payor Clinics
Louisville Medical Center
Ear Wax Removal
$150-200 + Office Visit
$40 (No Office Visit Fee)
Strep Test + Office Visit
$125 - $181
$350 - 650 + Office Visit
$100 Office Visit Included
$100 - 200
Covid Test + Office Visit
Test Price + Clinic Visit Fee
$15-25 + Clinic Visit Fee
$60 Office Visit Included
$500 - 820
$320 - 420
What is insurance great for? A lot of plans cover preventative screening tests at %100. Important things like mammograms, colonoscopies and so on are critical to early detection and effective treatment of cancers, for example. Because our clinic partners with providers of screening tests we do not yet provide, we can authorize those kinds of tests for you at your desired locations.
Insurance is also a wonderful thing to have in event of catastrophe. At any moment, disaster can strike and you could find yourself in need of an ambulance, trauma center or admitted to the hospital with a life-threatening illness. Insurance can keep you from bankruptcy if something that unfortunate happens.
In a nutshell, we believe that people should carry insurance if they can afford it. It enables people to have health care dollars taken from their paychecks to put toward preventative screening tests and a cushion in case of life-threatening illness or injury. But we also believe that health care should be accessible to EVERYONE. We want to return to allow Louisville to return to a day in which going to the clinic to be seen didn't inspire fear over how to pay a bill. We want Louisville to feel secure in knowing excellent care is being provided for a reasonable cost. Most of all, we want you to be able to have access to all the care you need, not just what your insurance company approves.
We are Louisville Medical Center. We provide individualized care that is patient-directed, private and affordable for all. We invite you to come in and check us out.