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  • Writer's pictureDr. Heikens

Do You Take Insurance? Why Not?

There are two questions that come up frequently during our initial discussion with potential patients.


Question 1:

The first question is either: “Do you take insurance?” or “Do you take my insurance?” We are proud to say that we can serve any patient regardless of their insurance coverage. HMO, PPO, Medicare, Medicaid, it’s fine. We just won’t be billing your insurance. There, that was easy!


Question 2:

The next question is: “Why don’t you take my insurance? I have a GREAT insurance plan (premium, platinum, etc)!” The answer here is more complex, but one important aspect of this is your access to your doctor.


Think about what happened the last time you felt you needed to be seen for a more urgent need (like possible ear infection or cough with fever, etc). For most people, when you call your doctor’s office with a relatively urgent need, you have a few options:


  1. You can wait 1-6 weeks (or longer in some cases!) for an appointment with your physician. In the meantime, your condition could resolve or worsen.

  2. You can make an urgent visit with a provider that you may have never met and who does not know you - so they don’t have as much background knowledge of you and your personal situation to help determine the best course of action. This could occur in an Urgent Care where you would likely have a higher copay,

  3. There is a third option as well: your physician can try to fit you into the schedule as an add-on appointment. But this is usually a rushed appointment that tends to frustrate everyone: you because your own appointment is rushed, other patients because their appointments are now delayed, and the physician because they just don’t have enough time.

Why is it like this?

Why does this happen? Unfortunately, in today’s insurance-driven, fee-for-service healthcare world, your physician only bills your insurance (and you for your copay) when they see you. For this reason, having an empty time slot in the schedule is seen as a financial loss, so offices struggle to fill every appointment slot every day. This does two things. First, it incentivizes the physician to see so many patients that they have very little time to devote to any one patient. Second, it means that physicians cannot save empty “urgent” slots so when you call in need, you are stuck with the three options outlined above.


“But,” some astute readers will say, “I have an HMO [health maintenance organization] plan, and I know that the physicians are not paid each time they see me, they are paid a certain amount of money per month for my insurance so they shouldn’t have the same incentive!”


Absolutely true, great observation! Unfortunately, in this case it is in the medical group’s financial interest to hire as few physicians as possible to see their patients, because they only get a certain amount of money each month per patient. For that reason, again, schedules are very full because there are so many patients needing appointments, which leads to the problem of - who are you going to see? See the three options above.


In the end, health INSURANCE is not the same as health CARE. A Super Double Platinum Premium Plan™ does not help you get in to see your physician. Our fee-for-service system actually created this mess whereby you can’t get seen by someone who actually knows you.





It doesn't have to be this way.


As you can see in the image above, we do things differently at Health Matters Direct Primary Care. We cut out insurance so we could eliminate the incentive to see as many people as possible in as little time as possible.


So what are our incentives? We want to have more time with our patients to develop long term relationships and provide high quality care while making an impact on our San Diego community by removing boundaries to that care. That’s it. Providing better care makes us happier doctors, and happier doctors tend to provide better care - it’s an amazing cycle!







We have structured our business model to keep the number of patients on our panel low enough that we can satisfy this singular goal. It’s right there on our website:


“This is the purest form of primary care, a relationship between your doctor and you.
You see your doctor. You text, email, or call your doctor. It’s efficient. It’s personal. It’s sustainable. And it’s what we dreamed about in medical school. We think you’ll love it too.”

So come join us! We can’t wait to share this model with you and work with you on obtaining your health goals in the future! Call us at 619-949-3479. Email us at hello@healthmattersdpc.com. Or go to our website to schedule a FREE meet & greet video visit with Dr. Anand or Dr. Heikens.


(PS: this doesn’t mean you should get rid of insurance, it’s still important! But it’s about what you use your insurance for, and what kind of insurance you maintain. Look out for a future post about this!)

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