News


In Mountain View, health care without the insurance

Patients pay directly for care, cutting out insurance middlemen, in return to old health care model, doctor says

A new primary care practice, which promises patients affordable care without any of the hassles often associated with health insurance, opened Wednesday (May 4) in Mountain View.

Founded by two medical doctors, M. Samir Qamar, and his wife, Hisana Qamar, MedLion charges patients a monthly $49 membership fee for access to an unlimited number of appointments. Patients are charged an additional $10 per visit — and that's it.

"It does sound too good to be true," Qamar said with a chuckle, noting that he is often asked whether his practice is some sort of underhanded scheme. "It is something that is almost a deterrent to our growth."

The key word being "almost." Qamar founded MedLion in 2009 in Monterey and said he began turning a profit within seven months.

In bypassing insurance companies and having patients pay him directly, he saves a great deal of money, Qamar said. That's because dealing with insurance companies is an incredibly complex, and pricy, process.

"A lot of the costs that doctors undertake are due to insurance companies' regulation," he said. "There is a lot of staff that is hired just for the insurance side of things. If the gym had to chase you down after every visit it would be quite taxing for them."

First a doctor's billing department calls the insurer and gives it specialized codes — one for the appointment itself and others for tests conducted or blood drawn. The insurance company then reimburses the doctors for each procedure. Sometimes the same insurer will pay different rates for the same procedure, depending on the individual patient's policy. This process can take a long time, leaving doctors footing the bill until the insurance company finally reimburses them, he said.

By eliminating the need for insurance specialists, MedLion's system of "direct primary care" saves Qamar somewhere in the neighborhood of 35 percent in operational overhead.

The MedLion system is not entirely new. Prior to the 1970s, Qamar said, most people paid their doctors directly for primary care. Those who had health insurance paid into plans that were intended to keep them from going bankrupt in the event of a catastrophic accident or the onset of a deadly disease. These plans had high deductibles, and, because they were a lower risk to the insurance company, lower premiums.

However, as the health insurance industry grew, it expanded into primary care. Premiums inched ever higher, and the system became more convoluted.

The direct-care model never entirely disappeared, but as all-encompassing health plans gained in popularity, a new "V.I.P" model of direct care with huge membership fees sprang up. These so-called "boutique medicine" doctors care for a small group of patients, and still make house calls, but charge hundreds, if not thousands, on a monthly basis.

In fact, Qamar has a V.I.P. practice of his own, and if it weren't for his experience caring for extremely wealthy patients as the house doctor for the Pebble Beach Resorts, he may have never founded MedLion.

Back in 2009 Qamar's wife — who runs Qamar & Qamar Medical Practice, an insurance-based primary care office in Monterey — began noting a sharp decline in business, as many of her patients lost their jobs and subsequently lost health coverage.

"I thought, 'I'm taking care of the rich and famous. Why not scale it down to cater to the masses and help as many people out in the community as possible?'" she said.

By cutting out house calls and other V.I.P. services, and increasing his patient load, Qamar figured he could significantly lower the cost of offering direct primary care. It worked, and the proof is in the opening of his second office, as well as in his optimism that MedLion will soon expand even further, he said.

He hopes to open new offices in the near future and said he is open to either hiring doctors and nurse practitioners, or even franchising the MedLion model out to other states.

Qamar is the first to acknowledge that MedLion is not a comprehensive health care plan.

"We're not promising care for the catastrophic," he said, recommending that anyone who chooses to become a member of MedLion should also look into a high-deductible health plan in case of the unexpected.

"We try to teach our patients to think of the health insurance industry like the car insurance industry," he explained. Car insurance companies pay for totaled cars or hospital bills those injured in wrecks. But the individual foots the bill for oil changes and blown gaskets.

Americans need to be more involved in the consumption of health care, Qamar said, and he sees MedLion, along with other growing direct primary care organizations — such as Qliance in Seattle and Symbeo out of New Jersey — as a means to that end.

It will be a challenge, Qamar said — "People are creatures of habit, and for the past 20 years we have expected our insurance companies to take care of us" — but the sooner "we break the mold" the better.

Comments

Like this comment
Posted by Local Observer
a resident of Los Altos
on May 7, 2011 at 10:12 pm

Great article and exactly what I've been seeking given my last two employers went belly-up, I've been out of work now for several years, and am subsisting on monthly social security until I can access my real retirement accounts later this year (it's an age-related issue).

Only one problem with the article: where is Medlion?

A Google search found this information at this website:

Web Link

525 South Drive, Suite 215, which means it's on one of the two roads flanking El Camino Hospital located on Grant Ave in Mountain View.

I haven't found a phone number for them yet.



Like this comment
Posted by Jeremy Engdahl-Johnson
a resident of Old Palo Alto
on May 8, 2011 at 11:33 am

Latest in our droid series -- Big healthcare reform question: How do health insurers set rates? Web Link


Like this comment
Posted by Md
a resident of Barron Park
on May 8, 2011 at 2:37 pm

Who will pay for specialists, labwork, surgeries, etc. Or that willbe provided to boutique patients? Or maybe specialists will accept $49/procedure. Going back to the sameconversation


Like this comment
Posted by Yup
a resident of Fairmeadow
on May 8, 2011 at 5:29 pm

The more "centralized and government controlled" health care, the less will be available to middle class folks...but the "rich" ( however it is defined du jour) will always be able to get great care through ever more expensive health insurance ( as it becomes ever more regulated to provide everything including the kitchen sink) and/or boutique care.

Oh, and the politically favored, like unions, will get great care too. Or the elected ones, like Congress.

It is just the rest of us, don't worry about it though.

Always remember, the more centralized and controlled an item, the more likely it is that ONLY the very rich ( connected as "rewarding our friends" to whoever is in power) will be able to afford the item. Witness old USSR, China, Cuba, Venezuela...do you think those in power and their friends used the "universal health care" system?


This is the beginning.


Like this comment
Posted by Frank
a resident of another community
on May 8, 2011 at 6:25 pm

Sounds great for basic health care. Once you need a specialist you are in trouble. Until this country goes to a single payer health care system anything else is a bunch of junk.


Like this comment
Posted by Yup
a resident of Fairmeadow
on May 9, 2011 at 6:29 am

Frank: I think you have an irrational belief in the taxpayer funded politicians deciding how good your health care should be.

I recommend you start with Miracle Cure: How to Solve America’s Health Care Crisis and Why Canada Isn’t the Answer", by Sally Pipes, move on to "10 Myths of American Health Care" by Sally Pipes, or her last book "The Truth about Obamacare".

This irrational belief that someone else can make better choices for you than you, as an adult, can, is the path to losing your ability to make choices.

Me, I prefer to be free to buy the health insurance I want to have, which means rolling back the extreme regulation over what every insurance must cover, which forces me to choose between insuring myself against medical care I would never choose at ridiculous insurance rates. Just start there, and we would see a tremendous drop in the insurance rates we pay...making it more affordable to all...letting us go back to MEDICAL insurance which covers what we want.

There are other good solutions also, but that would be a great start.


Like this comment
Posted by Garden Gnome
a resident of Crescent Park
on May 9, 2011 at 11:00 am

To those concerned about accessing specialists for $49 or whatever, that isn't the issue. Currently these specialists are forced to charge higher amounts to provide service, just as Qamar had to do. By omitting the bureaucracy they too will be able to offer their services for a more reasonable fee.

I would much rather pay more for specialists as I need them rather than wait for approval from an insurance carrier or the government.

I am quite taken with the optimism (naivete?) that my fellow correspondents have in the government's ability to make the right choice for me. As we've seen in the UK and every place else, single payer just doesn't work.


Like this comment
Posted by Steve C
a resident of Menlo Park
on May 9, 2011 at 11:02 am

It seems to me that everywhere that costs have spiraled out of control, insurance companies are lurking somewhere in the process. In everything from healthcare to home-ownership to financial derivatives, there is an insurance company somewhere pulling the strings. Seems to me that this is a step in the right direction, for physicians and consumers. Far better than the current model.


Like this comment
Posted by Scott
a resident of Menlo Park
on May 9, 2011 at 1:13 pm

We all need to have a stake in paying for our medical care. The current system that covers everything, including "oil changes and basic maintenance" using the car care analogy from the article, leads us, the consumers, to be careless about the costs. This leads doctors to be worse than careless about what they charge. It's always to their benefit if the bills are higher. Who can blame them. Unfortunately, the insurance companies don't have much incentive to try to keep the costs down, either. They just have to make sure other insurance companies don't get better deals. Then they pass the costs back on to us.
Basically, most consumers need to re-evaluate how they think about insurance. It's for losses we can't afford, not for every little nickle and dime. We should all be able to afford doctor visits up to a certain level. We'll all end up with more money in the end if we can cut the insurance companies out of the part of the business we don't really need them for anyway. Then, not only will we save on cutting out their middleman's fee on all the small stuff, but we get the whole consuming public watching their doctors, and I think costs will go down when they start having to think about whether a high fee would drive away customers.


Like this comment
Posted by Dave Chase
a resident of another community
on May 9, 2011 at 3:17 pm

This is fantastic to hear about. Last week, this TechCrunch piece spoke to how there's a "Do it yourself health reform" movement going on that MedLion epitomizes. In Seattle, there's a similar org called Qliance that has higher customer satisfaction scores than Google or Apple and all its Yelp scores at 5 stars (except one from a non-patient). For the reasons outlined here, models such as MedLion can and should explode in popularity.

You can see the TechCrunch piece at Web Link


Like this comment
Posted by Walter_E_Wallis
a resident of Midtown
on May 10, 2011 at 5:03 am

Walter_E_Wallis is a registered user.

Now if only judges do not interfere with the contract and add services. Judicial interference is where it all began. Birth control and Viagra as a medical necessity? Bah! Humbug!


Like this comment
Posted by Carlito Waysman
a resident of Old Palo Alto
on May 10, 2011 at 12:55 pm



When we let the health and lives of people be traded like any other commodity whether they be potatoes, cattle, corn, etc., the end result is what we have now, being the most powerful and wealthy nation on Earth's face, nevertheless in a free market driven health care, the number of their uninsured citizens on the tens of millions and growing due to the out of reach insurance costs.

And still those close minded and blinded rabid ultraconservative fanatic morons insist on denying those tens of millions of uninsured citizens of their right to a better life.

They give you a plethora of excuses: suddenly they have become aware of the government deficit, and they want to cut every single thing that doesn't fit their skewed political and religious beliefs,
they want to eliminate whatever little regulation the government has on private business, distorting every single fact that goes against their malicious agenda, and so on.

I strongly believe that a healthy citizenry is one of the best investments this Nation can make. Is not like is a big secret nowadays, look up to some European countries like Germany for example or Japan in Asia and lets give our people a better chance to have a healthier lives and a healthier country.


Like this comment
Posted by Ultra conservative rabid fanatic moron
a resident of Meadow Park
on May 11, 2011 at 11:59 am

Carlito: excuse me, but "close minded and rabid ultraconservative fanatic morons" want what you want..less expensive health insurance while preserving your RIGHT to buy what you wish to buy.

If you want less expensive insurance, stop voting for people who
FORCE insurances to cover silly stuff.


Bingo: less expensive health insurance, more people can "afford it". Link health insurance to a privilege, like driver's licenses, like we used to do with auto liability insurance, and BINGO, everyone who wants a driver's license will suddenly figure out how to pay for their now lesser cost insurance.

The conservatives want you to have choice in your life..we are the real pro-choicers, you can choose to pay for your insurance, like you choose your rent or mortgage level, your food intake, your exercise level, whether or not you smoke.all the choices that freedom brings you.

We don't want to steal from your pocket to pay for our choices, and we don't want you to steal from ours to pay for yours.

Live and let live, that is conservatism.

What is the opposite?

Tyranny.

Read anything by Orwell to get a clue. An "investment" by a government is legalized theft from individuals for what others want.

No. YOU are the radical, not I. YOU want government to take care of you, which means you want tyranny.


Like this comment
Posted by Ultra conservative rabid fanatic moron
a resident of Meadow Park
on May 11, 2011 at 12:03 pm

PS, Carlito, what do you think happens when the people who are paying for health care realize that the fat, smoking, drugging, non-exercising, poor choices people are costing them an arm and a leg? What do you think the payers will do to control your behaviors to make your health care cheaper for the payers?

Think about it. The road to tyranny is paved with "nanny state"...


Like this comment
Posted by Ultra conservative rabid fanatic moron
a resident of Meadow Park
on May 11, 2011 at 12:09 pm

To Steve C who said "It seems to me that everywhere that costs have spiraled out of control, insurance companies are lurking somewhere in the process."

You are on the right track..now keep walking and find out who is regulating the insurances, and a bunch of lawyers getting rich off of insane liability suits.

Guess what would happen if they were free to offer insurance that covered only what people WANTED, like they could 30 years ago. How much would that lower insurance costs?

Think about if the folks who sue had to pay the lawsuit costs of both parties every time they lost? How much do you think that dampen the spirits of silly lawsuits? How many attorneys would take hassle lawsuits to line their pockets?

How much did you pay 30 years ago for what was then called MEDICAL insurance? How much do you pay now for HEALTH insurance?

Think about it.


Like this comment
Posted by Ultra conservative rabid fanatic moron
a resident of Meadow Park
on May 11, 2011 at 1:37 pm

Who said "A lie travels around the world in the time it takes the truth to put on its pants" or something like that?

Looks like the truth is catching up.

57% favor a repeal of this disastrous "health care bill" by Obama/Dems

Web Link

I guess 57% of this country are ultra conservative rabid fanatic morons...


Like this comment
Posted by Alfred E Newman
a resident of Atherton
on May 11, 2011 at 3:28 pm

"conservative rabid fanatic moron":

Ras has always led the way with the repeal polls that tilt right. Note that 57% is down from a high of 63% by Ras, the previous week it was below 50%, per your link.

Note the word "SOMEWHAT" favor repeal.

Also note that most poll('s) terminology represents those who want to see the bill go further as "dissatisfied" by the bill. For example, those that preferred a Medicare for all buy-in, or single payer option, are usually listed as dissatisfied.

When poll questions allow a more detailed, granular choice, the numbers change dramatically.

"More registered voters want the law expanded than fully repealed, with the latter category amounting to less than a third.

A total of 49 percent want to let it stand or change it so it does more, versus 43 percent who want to scale it back or get rid of it entirely."

See Web Link January 14, 2011 USA Poll Release and Tables.pdf


"Poll: More want health law expanded than fully repealed

Earlier this month, some on the right got very excited by a Gallup poll finding that a plurality, 46 percent, want the health law repealed, versus only 40 percent who want to keep it in place. That poll, however, only presented two options: Repeal, or let the law stand as is.

Today brings a new Marist poll that takes a more fine grained look at public attitudes towards repeal, and its results are quite different. No one should be under any illusions: The health law is unpopular. But the picture is complicated. Marist:

Which one of the following comes closest to your opinion about what Congress should do with the 2010 health care law:

Let it stand: 14

Change it so it does more: 35

Change it so it does less: 13

Repeal it completely: 30"

- - - - - - -

For more healthcare fun and frivolity:

ObamaCare = RomneyCare ??

Let's see what Mitt says in his speech tomorrow about healthcare. Does he continue to run from his own plans? Flip-flop once more? Ignore it?


Like this comment
Posted by Alfred E Newman
a resident of Atherton
on May 11, 2011 at 3:31 pm

btw: it's usually credited to Winston Churchill....

"A lie gets halfway around the world before the truth has a chance to put its pants on."


Sorry, but further commenting on this topic has been closed.

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