Susan Pisano, vice president of communications for America's Health Insurance Plans, an insurance industry association, cautions that health insurers offer an important tool—provider networks. "Certainly, consumers who see contracted providers have lower cost sharing," Pisano says, because in-network physicians aren't allowed to charge more than the rate they've negotiated with the insurers. Pisano also notes that many people with insurance have the option to go out of network, which would permit them to see a cash-only provider. The hitch is that it's up to the patient to get reimbursed for whatever percentage the insurance company covers for out-of-network service. (Pisano notes that some out-of-network providers charge "several hundred or even a thousand percent more than what Medicare reimburses." So it's important to be clear about charges at the time of the appointment.)
Akers-Smith is comfortable with a high-deductible health insurance plan combined with paying out of pocket for routine visits to see Dappen at DocTalker. "We have the good fortune and blessing to be a pretty healthy family," she says of herself, her husband, and three sons, ages 14, 12, and 9. She appreciates the convenience of being able to get simple answers over the phone for a fee without a trip to the office. Dappen says he tries to be very accessible to his patients, providing them a direct office number, cellphone number, and E-mail address. Akers-Smith says that she always gets a response from the office within 30 minutes, even after business hours. "If I have a question, I can get my question answered," she says.