In another episode of Balls Deep, where humor meets healthcare, Dr. Joe Pazona, alongside his co-host Cat Williams, gives insight into the complexities surrounding modern healthcare. This week’s episode delves into a transformative shift in healthcare delivery: the direct pay and direct care model. This alternative to traditional insurance-based systems promises a return to the essence of medicine — simple, effective, and patient-centered care. Keep reading to learn more about direct care and what to expect for the future of healthcare.
What is Direct Care?
Direct care, also known as direct specialty care or direct primary care, eliminates insurance companies from the equation. Instead, patients pay their healthcare providers directly for services. This model gives doctors the freedom to focus entirely on patient care.
As Dr. Pazona put it, imagine it like any other business relationship — you purchase the services rendered to you, without any of the needless hassle created by insurance companies dictating what’s covered or not.
Why Make the Shift?
Why should you make the shift to direct care? Here are some of the frustrations of the current healthcare system that direct care can eliminate:
Limited Time with Doctors: Physicians often see up to 50 patients a day just to cover their operational costs, leaving little time for meaningful consultations.
Administrative Overhead: A significant portion of healthcare resources is spent managing insurance claims instead of providing care.
High Costs and Surprises: Even with insurance, many patients face exorbitant out-of-pocket costs due to high deductibles and hidden fees.
Dr Pazona mentions a shocking example: among the patient population of insured male patients seeking a vasectomy, two-thirds have claimed that they still paid the price in full because they had high deductibles.
Benefits of Direct Care for Patients
Direct care offers a dramatically improved healthcare experience for patients, including the following benefits:
Transparent Pricing: Patients know upfront how much they’ll pay. No surprise bills.
Better Access to Care: Patients can schedule appointments more easily and spend as much time as needed with their provider.
Streamlined Services: From answering phone calls promptly to providing follow-up care, the direct care model eliminates the hurdles that often frustrate patients.
According to Dr. Pazona, the goal is very clear: to prioritize patient health over paperwork.
What About Insurance?
Understandably, many patients wonder how the direct care model works alongside traditional insurance. Dr. Pazona recommends keeping catastrophic insurance coverage for major medical events, like surgeries or hospitalizations. Patients can still submit claims to their insurance company for some services via a “super bill,” though they must navigate reimbursement themselves.
The podcast also discussed alternatives to insurance, such as health-sharing plans, which pool resources among members to cover significant medical expenses. These plans often negotiate lower cash prices on behalf of patients, making healthcare more affordable.
The Bigger Picture
Dr. Pazona emphasized that the direct care model is part of a broader movement to reclaim healthcare from the grip of insurance companies. By removing unnecessary complexities, physicians can return to their core mission — helping patients achieve better health.
This shift isn't just for primary care. Specialists, including rheumatologists, cardiologists, and even surgeons, are embracing the model. These practices demonstrate that when healthcare providers focus on patients, the system works better for everyone involved.
Closing Thoughts
The direct pay and direct care model is more than a new way to manage healthcare — it’s reimagining the doctor-patient relationship. If you’ve ever felt frustrated by long waits, rushed appointments, and unexpected bills, this model could be the answer.
Dr. Pazona and Cat Williams captured it perfectly: Opting out of insurance allows doctors to opt into their patients, creating a system where everyone can thrive. Learn more about Pazona MD and its pricing model today.
Disclaimer
This podcast is for informational purposes only and does not substitute professional medical advice. Always seek the guidance of your healthcare provider for any medical conditions.
