Why We Don't Accept Health Insurance

At Swell Galveston, we believe that you have the right to choose what’s best for your health and your finances. In light of that, you have the right to choose traditional health insurance, a cost-sharing program, or another alternative that suits your needs, and we respect your decision no matter what you choose.

We don’t think that it’s wrong or unethical to have a traditional health insurance plan (such as a PPO, HMO, or Medicare), and we gladly welcome you as a patient if you have insurance. If you do have a health coverage plan, you may be wondering why our practice doesn’t submit claims through your plan, especially since many people have traditional insurance.

That’s a valid question, and one that we’re always happy to answer.! We understand that not using your health insurance for your outpatient healthcare needs may seem illogical and counterintuitive. While it looks that way on the surface, there are many good reasons to opt out of using your health insurance when it comes to certain types of outpatient testing and exams.

Since our ‘third-party-free’ practice is different than what most people are used to, we believe it’s our duty to provide a clear and detailed explanation as to why we don’t accept health insurance. Our reasons are both practical and ethical – our providers want to have the freedom to do whatever is necessary to improve your health, and they want to offer a good value at a fair price.

Our providers are unable to meet those goals when they have contracts with third parties, which is why our explanation starts with the unfortunate reality surrounding health insurance companies.

How Health Insurance Companies Work

A traditional health insurance company becomes a ‘third party’ when they get involved in the decision-making process of (what should be) a two-party setup. In our practice, we believe that a patient and their healthcare provider should be the only two parties involved in their health care decisions. Why is that?

The patient and their treating medical provider are the only people who have a vested interest in the patient’s health and well-being (with the exception of the patient’s loved ones).

When it comes to outpatient care, we believe that medical and financial expectations should be part of a direct contract between the patient and practitioner, so that both parties are treated fairly, and can enter into a mutually trusting, professional relationship.

When a third party gets involved, such as a health insurance company, the insurance company’s main interest is to pay as little as possible for the treatment of your health-related issues. While insurance companies have the right to make a profit like anyone else, there are certain ethical boundaries to be considered.

Because the insurance companies want to make as much money as possible, they go beyond their scope of expertise to make that happen. For example, they may require you to have unnecessary testing done — testing that won’t give you and your practitioner the answers you both need — in order for them to consider approving a more advanced type of treatment plan that your practitioner thinks is best for you. This approach may create delays in obtaining an accurate treatment plan.

The insurance company may even go so far as to deny you access to life-saving testing or treatment – that your practitioner deems necessary – in order to avoid making a payout. The truth of the matter is that insurance companies often attempt to override a medical practitioners direction for treatment.

This leads us to a very important fact:

Medical Insurance Does Not Equal Medical Care

As surprising as this sounds, having health insurance does not guarantee access to the medical care that you need. Medical insurance is not the same as medical care.

Medical insurance (commonly referred to as “health insurance”) is simply a financial contract where a fixed number of medical services are given to you (in exchange for monthly premiums) at the company’s discretion. Health insurance companies do not have the qualifications to determine what’s best for your health, yet they make those determinations every single day.

In a traditional healthcare setting, a health insurance company acts as a gatekeeper between the healthcare provider and the patient, both financially and medically. The downsides to insurance companies making these determinations are:

1.)    Even though the insurance company negotiates prices with various medical practices, those negotiated prices for tests and procedures can be (and often are) much higher than what the tests actually cost.

2.) Insurance companies have the power to deny a request for testing from your health care provider, or to reject a particular treatment plan.

While health insurance contracts provide coverage for certain outpatient medical tests and procedures, they usually only do so after you pay upfront costs (in the form of a deductible and an out-of-pocket maximum), and also under specific conditions. This can be very costly, as many out-of-pocket maximums can be upwards of $5,000 or more.

At Swell, we don’t believe it’s wrong to have traditional health insurance. In fact, we believe that having some sort of health insurance plan is a good choice in case you need in-patient care (such as long-term hospitalization or a complex surgery), or if you suffer from serious long-term medical conditions. We gladly welcome you whether you’re “insured,” “uninsured,” or part of a cost-sharing program – because we offer everyone the same fair-market prices regardless.

When we take a closer look at the problems with our modern healthcare system, we can see that insurance companies usually don’t make decisions based on what’s best for the patient – they make decisions based on what’s best for their bottom line. As a result, when it comes to outpatient care, practitioners are forced to cut down appointment times, to accept the arbitrary pricing set by the insurance companies, and to sometimes change their recommended medical plans due to denials from their patients’ insurance.

The Benefits of Being an Insurance-Free Practice

At Swell, we don’t have contracts with insurance companies because we want to have the freedom to offer our patients:

1.) Generous appointment times

2.) Timely scheduling for office visits (patients don’t have to wait months to be seen)

3.) Prompt access to any test(s) that they need, at cost! (no up-charging)

4.) Fair and transparent prices for every service

5.) It restores and preserves the provider-client relationship

6.) It enable our providers to spend time on what truly matters - delivering the highest quality of medical care.

7.) It enables us to offer lower prices due to substantially lower overhead

8.) It allows us to offer fair, transparent, market-based prices, which don’t need to be adjusted based on what a third party is willing to pay.

We want you to find value in what you’re paying for, and to know upfront what you’re going to pay. Why is this important? This gives you the tools you need to do price comparisons.

Even when an insurance company does authorize a certain test with a ‘negotiated’ rate, there are two main downsides:

1.) You don’t know the final price until after you’ve already had the test, and

2.) The negotiated insurance rate may or may not be a fair-market price. If it’s not, and if you have a high deductible, you will be responsible for paying the excessive charges.

For example, in a traditional insurance-based healthcare setting, an exercise stress echo test could cost a patient anywhere from $600 to $1,800 with insurance if they have a high-deductible plan.

While everyone has different experiences, we want to provide an alternative for those who have had medical or financial difficulties due to their insurance plans. Whether you choose to use your insurance for your health and wellness needs, or you choose to become a self-pay client at our practice (or other cash-based practices), we want you to be fully informed so that you can choose what’s best for your heart health and your finances.

We Want to Help You Reclaim Your Healthcare Rights

In summary, while traditional health insurance has certain benefits, it also comes with many costs that are not just financial, but also related to medical freedom.

Medical freedom is the right to choose your own healthcare provider, the right to undergo any type of medical testing or procedures that he or she recommends (if you wish to do so), and the right to pay a price that you and your physician deem to be fair for those services.

Medical freedom is important because it allows you to have control over your own healthcare needs, your medical privacy, and your healthcare budget.

In most cases, health insurance companies do not promote medical freedom. Instead, they often limit your choices when it comes to your healthcare decisions, which is ultimately why we have opted to not accept insurance – because your voice, your time, your health, and your right to choose are important to us.