Let’s face it: the American health insurance system is a total failure.
You pay through the nose for coverage even if your employer is subsidizing a big chunk of it. Then you pay a deductible, sometimes in the thousands of dollars. Then the rules are so complex that you never actually know what is covered and if so, how much. The stated charges for simple things, like an x-ray, an ER visit or setting a broken leg, are indefensibly high. Just x-raying and setting a broken leg costs an average of $2500-$3000. The bills get submitted to your insurance and magically shrink, giving you the impression that the insurance company is saving you money. In fact, their involvement in health care is largely responsible for ever-skyrocketing costs.
In the end, you never actually know the cost of anything. Imagine going to the supermarket and not knowing in advance what they will demand you pay for food until after you’ve already consumed it.
On top of that, if you want service, you sit in a room and wait. And wait. And wait.
An Alternative to Health Insurance
Entrepreneur Frank Wells saw how poorly all this was working for customers. You know, customers? In health care, no one calls you the customer. They call you the patient because you must be patient or the health care system will drive you crazy.
“I saw people stop going to the doctor because they didn’t want to pay $250 for the visit,” he lamented.
Wells served as CEO of HealthFirst, a series of urgent care centers in the Lowcountry. In order to do business, the company had to work with more than 600 insurance company plans. It had to file claims and try to collect from 600 different plans. It had to write contracts with 600 plans. It had to register all the physicians and physician assistants and nurse practitioners with 600 plans. It had to audit its billing for 600 plans and defend its charges to 600 plans. The insurance operation consumed more costs than all the patient care they delivered.
Yes, more than half your bill covers insurance paperwork, not the care being delivered.
Wells wondered whether it would be possible to eliminate the insurance company nonsense and deliver urgent and primary care directly to patients. Five years ago, he and his team opened Renew Medical urgent care and found that the self-pay model worked fabulously for patients and profits alike.
Holy City Med is Faster, Better and a Fraction of the Cost
Which brings us to today. Wells and his partners have opened Holy City Med, providing primary and urgent care to businesses, their employees and individuals in the Lowcountry without the interference of insurance companies. The result is health care at a fraction of the cost of “insured” care.
Consider this: a business can buy a membership for each employee for $37/month. For each dependent, it’s another $27/month. For that, they get unlimited well visits, urgent care, primary care, diagnostics like x-rays, EKG, in-house labs, strep and flu tests, and more, all for the low, low price of nothing.
You read that right. Once the membership is paid, visits are free and unlimited to the purple-striped clinics at 2039 Savannah Highway in West Ashley, right across from the 526 exit, and 5479 North Rhett Blvd. in North Charleston, also near the 526 interchange, anytime between 8 am and 8 pm Monday through Friday or 8 am to 5 pm Saturday. No copay. No deductible. No contracts. No kidding. How? No insurance companies.
Coming in the next year will be more Holy City Med clinics in Summerville, Mt. Pleasant and Dorchester Road in North Charleston, plus expanded hours for greater customer convenience. In the meantime, video medical visits are free and unlimited.
For those not part of a company, individual memberships are just $75/month, plus dependents, for the same urgent and primary care. Even if you don’t have a membership, walk-ins are charged just $97 for one-time care.
Break a leg? They will x-ray it, set it and put you in a cast as part of your membership. If you need crutches, Holy city Med will sell them to you for $20, not the $60 the hospitals gouge from you. “We paid $16.50 for those crutches,” Wells notes. “We make our money on low-margin and high-volume.”
Sore throat? Come to Holy City Med and get a strep test and a prescription, but no bill.
Diabetic? Get your A1C and lipid tests as part of your membership. You still need to see an endocrinologist, but Holy City Med makes referrals to low-cost specialists who offer deep discounts to self-pay customers.
Different Is Better in Health Care
It’s not as if Holy City Med is saving money on staff. They employ docs and PAs with extensive experience in emergency rooms. Whatever you have, they’ve seen it before. Holy City Med saves you money by booting the insurance companies out the door. Or, for those who have insurance, supplementing it with unlimited preventive care visits.
You can’t talk about business today without mentioning Covid. Holy City Med offers rapid testing for $100 ($80 for members) via their drive-thru. Results are sent in about a half hour. They also offer the PCR lab test for $100 and will test for the antibodies for $80. That is a blood test and must be done in the office.
Now the elephant in the room: what about catastrophic care? What if you have a heart attack, or an appendectomy, or need cancer treatment? That isn’t primary care and the costs can bankrupt a middle class family. For that, Wells says, a catastrophic care plan is necessary. Those can be purchased separately through the marketplace, but many employers that work with Holy City Med, including Holy City Med itself, contract with cost-sharing companies that offer low-cost coverage for health care that is technically not insurance. They can offer discounted coverage because, remember, insurance more than doubles the cost of care.
Nothing about this arrangement prevents an employer from picking up some or all of the cost of providing this care, just as it does now. Employers that care about the health of their employees, but are concerned about the overbearing cost of health care today, can find a solution by partnering with self-pay providers like Holy City Med and the various health sharing plans.
Wells says the only thing preventing everyone from finding a better solution to the current cost of health care is lack of knowledge and resistance to change. “Our big hurdle is educating people beyond their current behavior,” he said.
“They think they need insurance, but in fact, they need options to consider instead of the insurance that is driving up their costs.”