Dr. Tea  0:01  

Practicing medicine without insurance is possible. Imagine a private practice where you get to see your best patients every day, providing medical services you truly enjoy, all without the hassle of insurance. My name is Dr. Tea Nguyen, and I'm a recovering specialist who was completely burned out from insurance based medicine. I pivoted into direct care, where patients pay me directly for my medical services, and have never looked back. If you're a private practice owner or planning to become one who's looking to be free of the grind of insurance and you're craving it, simplicity, efficiency and connection with patients, you are in the right place. This podcast will help you map out your exit plan and uncover the mindset needed to thrive in today's economy. Welcome to the Direct Care Podcast For Specialists. 

Dr. Tea  0:54  

Oh, Medicaid. Medicaid, Medicaid. This is the state funded insurance for low income individuals who may not be eligible for other types of insurance. It's been a blessing for many, and it's been a total headache for others, like doctors who want to give quality care and sustain their business. Let me elaborate. I had a situation where a patient had Medicaid insurance and I was trying to connect her with a DPC doctor, because she needs it. She needs a concierge level of care and direct primary care doctors. I know I can communicate with them freely and directly by text or email, and you know we're on the same wave length. We just know and have the ability to have open communication. And I know they're not burned out, so I don't feel like I'm bothering them when I'm asking them questions. So I tried to connect a patient with a DPC doctor, and the patient had Medicaid, and the state that they're in, Nevada, is restrictive in a way where the DPC doctor said she could not care for this patient because of those restrictions. What are those restrictions? Well, some states will not allow a patient to receive state funding for their insurance through Medicaid and allow them the freedom to choose a private, contracted doctor, which is a direct care doctor or concierge doctor, because the assumption is, if you're low income, how could you afford anything else? Right? In Nevada, I don't know the state laws, but I do know from talking to the TPC doctor that there are restrictions to be aware of, and I wanted to share that with you. In some states, Medicaid won't accept your orders. If you're not a Medicaid provider, that could be true for other insurances as well. There are closed networks such as Kaiser insurance, where if you're not a Kaiser doctor, you really can't prescribe medications or lab orders to be filled at a Kaiser facility. So what is the workaround in cases where patients want to pay out of pocket, you would either have to provide them the option of paying out of pocket outside of their designated facility. So for example, if you're in a Kaiser area, you would tell the patient you can either pay out of pocket at a non Kaiser facility. Don't even run the insurance, that nobody knows right or what I normally do, because I'm a specialist, I would give my note to the patient and have the patient communicate my findings and my recommendation with the Kaiser doctor. So do the Kaiser doctors care about what I have to say? Probably not, because sometimes the benefit to Kaiser, the Kaiser system, is to retain all of the work so it stays in house. And I believe, based on what other Kaiser doctor friends have told me, they get penalized if they refer out or if they don't utilize their system. 

Dr. Tea  3:56  

And so maybe I run into a PCP doctor at Kaiser who takes my recommendation, maybe they don't, I really don't know. At that point, it's out of my hands, which is why I help patients advocate for themselves, because if they truly feel unheard and they're not getting what they need, then they'll have choices. And so I offered the patient those choices either go back to your primary care and let them know what my findings were, and let them decide what the next step for them is, or they can pay out of pocket directly and go to this facility, or go to this lab and pay out of pocket. And the thing is, is this is not about putting down other doctors, not at all. This is about the system that is incredibly broken, and the workarounds we have to find the creative problem solving skills we have to develop in order to advocate for our patients, because patients don't know they don't know as much as we do as doctors, and so I fulfill that role as an advocate to let patients know their options.Whether it be about a surgery, a second opinion or whatever, but also how and where they can get care regardless of their type of insurance. Because I don't think people need to be judged about what their economic status level is based on the insurance they were provided or have chosen. I think that's really unfair. What you need to know is that Medicaid does have restrictions because it's government funded, and in some states, like Kentucky, I believe they don't allow patients to contract privately with a doctor who is not a Medicaid doctor. That's a very strict law. So I would pay attention to that, and that's why I advise you to get a health care attorney who knows your state very well and reach out to an attorney who has worked with direct care doctors. That's the safest thing you can do for yourself. So I'm in California, and I bet I do have patients who have Medicaid, and sometimes the less I know, the better. 

Dr. Tea  6:00  

To be honest, the only time I ask for patients' insurance is that if I have to order a medication or a lab order or something like that, I'll ask them if they want to pay out of pocket or if they want to try to use their insurance. And because I do know Kaiser is very restrictive, I do ask if they have Kaiser. It's not Medicaid insurance, it's private insurance, but it's an in network system. It's a club, right? If you're not part of the club, you're you can't do anything there. So that's something for you to be aware of. I'm sure there are other systems of a similar nature, where if you're not within it, you can't be an ordering provider. So some food for thought, things to think about if you're a specialist and you want to take care of these people who have these restrictive insurance give them options. So the things that I use in my practice include Ulta lab.com, you can set up an account there. And what I've been told privately is that I can't display the prices of those labs publicly, because they do contract with lab core and quest, and so if patients use their insurance, that's a different rate. But I can tell you that the cash rates are very reasonable. If you were to use this avenue instead and just tell patients it's just cash, you can either have the patient pay the lab directly, or what I do is have the patient pay me, because the lab will charge me for that. You can choose to tack on additional professional fees, if you like, but usually it just comes with the cost of the office visit for me, so I don't add more on top of ordering labs that just come with the visit. And you can decide how you want to price that out. You know, I think it's really cool to have that option to let patients know that it's kind of like a back door alleyway to get what you need without all the fuss. So I think it's a cool secret that we hold, that we can help patients navigate the system now that we have a practice that is not volume based, so we can take the time to help patients know what they can do with their situation. And so for the patient I initially started with, before I let the patient know that their insurance is just restrictive, and if they wanted more high level care, more personalized care, they need to look at a different insurance entirely. 

Dr. Tea  8:19  

Medicaid is going to have a lot of restrictions, and so maybe choose Medicare when the time is right, or choose private insurance, or choose to not have insurance at all. You will hear a lot of direct care doctors say, have some level of insurance for catastrophic care. I don't think you'll hear many of us say, don't have insurance, because that would be irresponsible. Some level of insurance for peace of mind is the recommendation that direct care fills the gap of what insurance cannot provide, and it provides all people peace of mind. Now, since we are a family here on this podcast, we are a little community. If you have additional resources to share, I would definitely love to hear about it. There's a button down below that says, send us a text or a question or it's something for you to communicate with me. You can just quickly click that and type in stuff that you're using that's been helpful for you and your patients. And I would really appreciate that. I really love working with companies who just get it. They know the value of direct care, and I've even had previous episodes where I talked about brokers, or they're not really called brokers, I guess, but they are connectors of employers who connect with direct care doctors because they're bypassing all of the hassles of insurance while lowering expenses, having higher quality care. And everybody is happy. The doctor is happy to get paid what they need to get paid. The patient's happy to getting the high quality care that they need to get. The employer benefits in knowing that their employee will have good care. Higher, and they're reducing their expenses too, so they're taking a chance on this model to help retain their employees health and to spend less. So I love that. So that's just a little gem I had for you for today's episode. It's a shorty, but I wanted it to be clear, I wanted it to be quick, and I wanted you to continue to protect your business and your reputation by keeping you aware about what's going on in the direct care space. 

Dr. Tea  10:28  

Now this month, February of 2025 is my third year producing content for this podcast, and it's been such a joy and a pleasure to talk to you about something that I care so deeply about and how it impacts other physicians lives so positively and their community, because they're no longer burned out. They're finally doing the work that they deeply enjoy, and I'm so grateful to be a part of that journey. So for this month, I just wanted to let you know that I have a few openings to help a few more doctors through one-on-one coaching to help them launch their direct specialty care practice. So I do this for a select few. I want to be able to maintain a high level of focus on those doctors who are serious about starting their direct care practice. If you're interested in having me as your coach alongside you, as you take on this path, connect with me on LinkedIn and just shoot me a DM and let me know that you're interested. What I'll do is I'll start you off with an assessment so that I can understand what might be holding you back from chasing your dream, and then walk you through the path of what it would look like for your specialty. I'm so grateful that you're here and for sharing and for letting people know about direct care. This is the only way we can move forward, is if we do this collectively, together and we continue to share our resources. I'll check in with you next week. Take care. 

Dr. Tea  11:53  

If you enjoyed this episode, please give it a review and share it with a friend so more doctors can learn about direct care. Let's keep the conversation going on LinkedIn so we can help more doctors escape insurance and thrive in private practice. Thanks for listening. I'll talk with you next time take care. Bye.