Originally created 06/17/04

Care Card offers discount rates



Sitting with his three children in the pediatrician's office, John Pinion watched as his youngest, 3-year-old John, put on his sunglasses and then shyly covered his eyes with his hands while Dr. Halbert Capuy tried to reassure him.

The visit, one of many to the pediatrician this year, took care of John's sinus infection. But more than likely, the Pinion brood will be back to see the doctor sometime soon.

"They're in pretty frequently," said Mr. Pinion, 31, of Evans. "When one gets sick, it just goes right down the line."

His family has health insurance, although the rates increase each year, Mr. Pinion said. Between co-pays, monthly premiums and other insurance-related expenses, he admits the coverage is expensive.

But not everyone is so lucky.

Between the unemployed, those who can't afford increasing health insurance deductibles and those employed by small companies that don't provide health insurance, nearly 44 million Americans lacked health care coverage of any kind for one year, according to the U.S. Census Bureau.

"We are seeing more and more families now that are not covered under any kind of medical insurance," Dr. Capuy said.

That's why Dr. Capuy's office, the Pediatric Group of Augusta, is one of 80 locations in the CSRA involved in an innovative approach to medical care.

The Care Card, created by Doctors Direct of the CSRA Inc., a company made up of nearly 50 local physicians, works like a Sam's Club membership, said Gus Merkle, the company's president.

By paying an annual fee, patients will receive discounts on in-office medical services with participating physicians in Burke, Columbia and Richmond counties in Georgia and Edgefield and Aiken counties in South Carolina, Mr. Merkle said.

Each time a patient sees a physician, he is charged a fee based on the complexity of the medical condition, the time it takes to treat it and other factors.

"Our motivation was really very simple," Mr. Merkle said. "Our job as primary care physicians is to keep people healthy and to make them healthy again when they're not. In order to do that, people have to have affordable means to be seen at our offices."

This plan will not affect Mr. Pinion or any of Dr. Capuy's patients who do not wish to participate in the Care Card program.

The Care Card is similar to another program founded on the West Coast. SimpleCare, created by two Washington physicians, Drs. Vern S. Cherewatenko and David MacDonald, offers what they say is a simple solution to rising medical insurance costs.

Like the Care Card, SimpleCare, which has participating doctors across the United States, including in Augusta, lets patients pay for routine medical care up front instead of being billed by insurance providers later.

Health insurance companies serving as the middleman are removed from the equation, thereby eliminating piles of paperwork physicians must complete and time spent over the phone in the billing process. SimpleCare's formula claims doctors can charge a fair price for services without the administrative hassles and bureaucracy associated with billing, insurance forms, referrals, payment delays, claim denials and other managed-care costs.

Advocates of such no-insurance plans say doctors give better care and reduce billing and administrative expenses.

Many policy experts are carefully watching the health insurance situation and the effort by physicians to bring affordable medical care to their patients.

"I think it may be a little early to call it a trend, but there is definite interest across the country," said Kelly McCutchen, the executive director of the Georgia Public Policy Foundation in Atlanta. "There's a lot of frustration with the amount of administrative cost in health care. This whole idea in getting back to paying in cash for routine medical expenses just makes common sense."

John Oxendine, the insurance and fire safety commissioner for Georgia, said it is important for physicians and others involved in the health care field to think of new ideas to improve the nation's health care system.

"There are a lot of different alternatives coming out there," he said. "It's actually something we encourage. We do want to have people being imaginative. We need good ingenuity in this area. We know the health care system we have is flawed and not working. Only through the ingenuity of our citizens are we going to come up with other solutions to fix this."

The idea of saving money by eliminating health insurance companies is one that appeals both to physicians desiring to practice medicine without a financial overhang and to the patient who can't afford to visit the doctor.

Over the past few years, Mr. Merkle said, Doctors Direct of the CSRA has seen many patients drop their insurance plans because increasing deductibles make it too expensive to see the doctor. Patients then wait until the medical problem is so bad they must visit the emergency room, Mr. Merkle said.

The Care Card is not an insurance policy; rather it is a way for uninsured patients to access health care without breaking the bank, Mr. Merkle said.

Although the Care Card does not cover prescription medicine or hospital visits, the physicians involved in the Doctors Direct of the CSRA believe in the program.

"We can discount our charges pretty significantly," said Dr. William Rivell, a participating physician. "I don't see a downside to this."

Reach Kate Lewis at (706) 823-3215 or kate.lewis@augustachronicle.com

How Care card works

  • Patients pay an annual membership fee ranging from $72 to $132.

  • Physician office fees range from $35 for a "brief" visit to $95 for a "complicated" visit.

  • There are no deductibles, limits on office visits, age limitations or exclusions for pre-existing conditions.
    For more information on the program, call (706) 733-1776 or go to www.doctorsdirect-csra.com..