Dr. Timothy Ames believes the times in health care are a changin'.
Even though the rate of Americans without medical insurance has dropped in recent years, many people are paying more for health care.
So Ames decided to simplify things.
At his practice in Portage, he charges a monthly fee for unlimited visits: by phone, by text, after hours. He doesn't accept insurance. His subscription is $20 per month for children, $75 for adults aged 51-64, and $50 or less for all other adults.
He passes on his savings in overhead to his patients in the form of time. He spends more of it with his clients than doctors at a regular practice would, he said.
"There is an appetite for something different," Ames said. "We're seeing more people that have had difficulty getting access to services, despite having insurance in many cases, because the out-of-pocket expenses that accompany insurance are rising every year. Insurance should be for very large and unpredictable expenses, instead of small and more predictable expenses."
More using self-pay option
With rising deductibles and out-of-pocket health care costs, there are an increasing number of medical facilities in Northwest Indiana that charge cash prices in lieu of insurance. And with the changes to Obamacare, namely the repeal of the individual mandate that requires people to have insurance, these practices could continue to increase in number into the future.
Dr. Vijai Kumar runs Highland-based Health Diagnostics of NWI, which offers cash prices for medical diagnostic work. He said his prices end up being less than what people would be charged even if they used insurance. Comprehensive health screenings — which include blood work, urinalysis, a thyroid test, echocardiogram and prostate cancer screening (for men) — are $250 for men and $230 for women.
"I decided money should not come into the picture of health care. We don't become doctors to make money," he said. "When people come in, they're happy because they saved so much."
Kumar believes he's not only saving people money but improving their health as well. People don't have to put off testing because they can't afford it.
"If the tests are $1,200 at the hospital, that's a paycheck for two weeks for many people," he said. "They won't get it done, and if they don't get it done, they suffer. They're delaying treatment: It could be diabetes, kidney disease, something serious."
M. Fraz Satti, owner of St. Mary Open MRI, has a similar practice in Highland, but for imaging. He said he can get away with charging low cash prices because, unlike hospitals, he doesn't have a lot of overhead. An X-ray, for example, is $80, while an open MRI is $350.
"I don't have an IT guy here full time. I call him when I need him. Hospitals have IT teams," he said. "Hospitals also have a lot more expenses and a strong lobby and can twist insurers' arms."
He noted that many of his patients have health coverage.
"What I am noticing is even the patients who have insurance, their plans have high deductibles and they don't want to use insurance," he said. "More and more people are using our self-pay option."
Less time with insurance, more face time with patients
Physical therapist Sean Lee offers cash prices at his Merrillville practice, Southlake Rehab. Patients can get physical therapy for $60 for an hour to an hour-and-a-half visit, and do payment plans for as little as $50 a month.
"Nowadays insurance has high premiums. When people use it, it doesn't cover much," he said. "This is something you might want to watch for in the future. I expect more clinics might do this."
As a small business owner, Lee knows what it's like to not have health insurance.
"When people don't have insurance, when they need services, they might go without them and go through severe pain," he said. "It's financially very hard for them."
Dr. Juana Ambriz de Williams charges $75 a month for unlimited physical and mental health visits at her Valparaiso direct primary care practice, Dunes Family Clinic. She sees patients on the weekends and in the evenings. She even has some medications available at her office.
Not having to deal with insurance companies gives her more time and flexibility for her patients.
"People are very aware of how they're spending their health care dollars," she said. "We're growing at a steady clip. The trend is moving forward, especially in direct primary care.
"With health care changing and deducibles getting higher, people are looking for ways to control costs, especially when they know that every dollar counts and deductibles are getting higher every year. They're coming in, even with insurance, to control how much they spend on health care."