What is a Third-Party-Free Practice?
Trinity Heart and Vascular Group is a third-party-free cardiology practice – the first in northeast Tennessee. We’re happy that you’re interested in our services, and we’re honored to serve our local communities of Johnson City and Greeneville, as well as the Appalachian Highlands and beyond.
If you’re unfamiliar with the ‘third-party-free’ practice model, we’re here to explain exactly what it is, what the benefits are, and why it’s becoming a popular alternative.
To see all of the content on this page, you can simply keep scrolling. If you’d like to go directly to a specific topic, click on any of the topics below in the Table of Contents.
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Table of Contents
The Definition of a Third-Party-Free Practice
What does it mean when a medical practice isn’t connected to third parties? Let’s take a closer look.
A third-party-free medical practice:
· Is privately and independently owned
· Is not governed by a healthcare system or hospital
· Doesn’t have contracts with insurance companies
· Sets their own prices (which are often much lower than insurance-negotiated prices)
· Communicates directly with their patients regarding all medical decisions
In other words, ‘third-party-free’ medical practices do not bring any ‘third-party payers’ (i.e., health insurance companies) or other types of ‘third parties’ (such as corporate healthcare systems or the government) into the mix.
The medical providers in these practices are considered “out-of-network” for anyone who has medical insurance (including Medicare).
Who Can Be Treated at a Third-Party-Free Practice?
Anyone is welcome at a third-party-free practice, whether they have insurance or not. This means that any individual who has health insurance through their employer, is self-insured/uninsured, or is part of a cost-sharing program can become a patient at this type of practice.
For the patients who have health insurance and want to be seen at a third-party-free practice, they have the option to opt out of using their insurance at that particular practice. This means that they can still use their insurance with other providers that accept insurance, but they won’t use it at the third-party-free practice.
When they do this, they become a ‘self-pay’ patient at that practice, which means that they pay the provider directly at the time of service (instead of submitting a claim to their insurance company and waiting for a bill in the mail). A major financial advantage is that the patient will most likely save a considerable amount of money if their insurance plan has a high deductible.
If a patient’s insurance company provides out-of-network benefits, and agrees to reimburse them, they (the patient) can submit a charge sheet to their insurance company for reimbursement.
What are the Benefits of Becoming a Patient at a Third-Party-Free Practice?
While this isn’t a ‘one-size-fits-all’ approach, there are notable benefits when utilizing a third-party-free setup for outpatient needs. First, medical providers are able to work directly for their patients (not the patients’ insurance companies or other third parties), which means they are able to spend quality time with each patient.
When an insurance company is involved, a provider spends copious amounts of time filling out paperwork for the insurance company, and also following that company’s rules and regulations, which means that he or she has less time to focus on their patients. There are many talented and qualified medical providers who desire to spend more time with their patients, but are unfortunately unable to do so because of the time it takes to fill out insurance forms.
The second benefit is that providers in a third-party-free practice have the freedom to make medical recommendations that serve each patient’s best interests.
When insurance is involved, providers want to do what’s in their patients’ best interests, but are sometimes forced to change a patient’s treatment plan if that patient’s insurance company denies a request for an evaluation, testing, and/or treatment. Insurance companies usually refuse to authorize a test or treatment plan when they don’t want to pay for any part of that medical service, or to delay their cash outflows.
A patient should never have their treatment plan altered based on what their insurance company is willing – or not willing – to pay. It’s not ethical, and it puts the patient and their physician in a compromising situation.
In an insurance-free practice, your physician has the freedom to provide you with a treatment plan and any recommended testing or procedures that he or she deems necessary. Your well-being is the driving force behind all of that – not the financial interests of the insurance company.
Why is This Type of Practice Becoming Popular?
To put it concisely, the main reason is that patients have the freedom to do what’s best for their own health. When you come to a third-party-free practice, it’s about healthcare on your terms and the provider’s terms (not the terms of a third party). This medical freedom allows you to:
· Choose your own medical provider
· Spend more time with your medical provider, and thus establish a trusting relationship
· Book an appointment quickly
· Have your medical needs addressed in a timely manner (You don’t have to wait months to be seen)
· Have direct access to testing and procedures that are priced at a fair-market value, without the risk of being ‘denied’ by an insurance company
· Save hundreds (or even thousands) of dollars on specialized care if you have a high-deductible or are self-insured
· Maintain privacy when it comes to your medical records
While there are multiple benefits to a ‘third-party-free’ approach, we understand that this isn’t a perfect fit for everyone, and that’s okay! This is simply an alternative for those who are looking for something different.
We also understand that this is not a common setup in the United States, and as a result, it can be a daunting subject to delve into.
If this is your first time reading about ‘third-party-free’ medical practices (or if you are familiar with them, but want to learn more), we encourage you to read our other educational resources that explain why we do what we do.
We want each and every person who comes to our website to be fully informed about their options regarding their healthcare decisions. No matter what type of medical practices you prefer — ones that accept health insurance, ones that are third-party-free, or both — we believe that education is the key to obtaining the healthcare that’s right for you, and we’re here to help.