A calculus of mOOP

DPC practitioners seeking to recruit insured patients often tout that the cash costs for primary care services and/or for downstream services procured through the DPC entity (e.g., advanced radiology) might be lower than even the patient cost-share for the same services procured under the insurance policy, especially high deductible policies. Patients should, however, carefully consider that paying for service “out-of-pocket-and-out-of-plan” may entail costs that result from not having those payments count toward satisfying deductible or mOOP amounts.

Here’s an example of an extraordinary calculation involving an MD with an MBA, one largely turning on the surprising claim that, for his insurer, an insured in the deductible phase must pay full retail pricing for labs and prescription medications.

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