Why Choose Direct Care If You Have Health Insurance?

Many patients ask a very reasonable question:

“If I already have health insurance, why would I pay to see a physician through direct care?”

The answer is simple: it depends on what you value most in your healthcare experience.

If you value timely access, easy communication, and continuity with your physician, direct care may be the right fit for you.

What Is Direct Care?

Direct care is a healthcare model in which patients pay their physician directly, rather than billing insurance for every visit. This is often done through a monthly membership or transparent flat fees.

Insurance still plays an important role. It is typically used for:

• Hospitalizations

• Imaging (CT scans, MRIs, ultrasounds)

• Laboratory tests

• Procedures and surgeries

• Medications

Direct care focuses on the part of medicine that matters most day to day: access to your physician and ongoing care.

Why Isn’t Insurance Alone Always Enough?

Insurance helps cover large and unexpected medical costs. However, it does not always guarantee:

• Quick appointments

• Unhurried visits

• Easy follow-up questions

• Direct communication with your physician

• Continuity over time

In many traditional systems, physicians must see a high volume of patients, leading to short visits and long wait times. Direct care removes many of these constraints.

Key Benefits of Direct Care

1. Prompt Access

Patients can often be seen much sooner, sometimes within days rather than weeks or months. This matters when symptoms change or labs need to be addressed promptly.

2. Easy Communication and Follow-Ups

Direct care allows for:

• Simple follow-up questions without scheduling another visit

• Timely medication adjustments

• Ongoing guidance between visits

This is especially valuable for chronic conditions such as kidney disease, hypertension, diabetes, and weight management.

3. Continuity of Care

Direct care supports a long-term physician–patient relationship. Your doctor knows your history, your goals, and how your health changes over time.

This is how medicine was practiced for many years—before insurance paperwork and productivity metrics dictated the pace of care.

4. Transparent and Predictable Costs

Direct care offers clear, upfront pricing without surprise bills or facility fees. For many patients, this can also be a cost-effective option.

A Real-World Cost Comparison

Consider a patient with a high-deductible health plan who has not yet met their deductible.

Traditional Insurance-Based Care

Many specialist visits, especially in hospital-owned practices, include a facility fee.

Typical per-visit charges:

• Physician visit: $300

• Facility fee: $200

• Total per visit: $500

Over one year:

• 4 visits × $500 = $2,000 out of pocket

• Follow-up messages or calls may not be included

• Additional visits result in additional charges

Four visits per year is very common for patients managing chronic medical conditions.

Direct Care Model

Direct care membership:

• Monthly fee: $160 or

• Annual cost: $1,800

This typically includes:

• Monthly visits if needed

• No per-visit charges

• No facility fees

• Easy communication between visits

• Direct access to your physician

• Ongoing continuity of care

What Does This Mean in Practical Terms?

For roughly the same annual cost:

• Traditional care may cover four visits

• Direct care allows you to see your physician monthly, with access in between

Rather than paying for each individual visit, direct care supports continuous, proactive care.

Who May Benefit Most From Direct Care?

Direct care may be a good option if you:

• Value quick access to your physician

• Prefer unhurried, thoughtful visits

• Want easy follow-ups and communication

• Have a high-deductible plan

• Are uninsured or underinsured

• Manage ongoing or chronic health conditions

The Bottom Line

Direct care is not a replacement for insurance. It is a different way of accessing your physician—one that prioritizes time, access, continuity, and transparency.

If those are the aspects of care you value most, direct care may be the right choice for you.