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Giving up on Insurance System: Falmouth Practice's 10-Year Experiment
07/02/2013   Reported By: Patty B. Wight

Even as U.S. health care is under reform, some doctors still choose to work outside the typical model of care. Yesterday, we visited Dr. Mike Ciampi, a South Portland primary care physician who no longer accepts insurance so he can spend more time with patients and charge less. Some question whether such a model is sustainable. But as Patty Wight reports in the second of our two-part series, that has been the case for a health practice in Falmouth that hasn't accepted insurance for more than 10 years.

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Dr. Sunny Raleigh and Cathy Patnaude

Dr. Sunny Raleigh, left, with patient Cathy Patnaude.

When Dr. Sunny Raleigh gives a physical at True North health center in Falmouth, it differs from what most patients might expect. For starters, patient Cathy Patnaude hasn't changed into her exam gown yet. And instead of sitting on an exam table, she sits in a chair directly across from Raleigh, who wants her to feel as comfortable as possible as she asks detailed questions about all aspects of Patnaude's life - things like family, work, and food.

"So, can you kind of walk me through your last 24 hours of nutrition?" Dr. Raleigh asks Patnaude. This is just the beginning of an appointment that can take up to 90 minutes. It's what distinguishes True North from other health practices, says Medical Director Bethany Hays.

"Probably the biggest difference is the practitioner who sits down with you and says, 'Tell me your story, and give me the long version,'" Hays says. "That doesn't happen in many doctor's offices, and I'm not being critical of doctors - it's the system."

True North was opened just over 10 years ago by a group of nurses and physicians who were disenchanted with the health system. They wanted a practice that would allow them to get to the root cause of patients' health issues. That requires time, which is something in short supply when you're tied to insurance reimbursements.

"The business of medicine has gotten so complex and so burdened by administrative and organizational issues that physicians are tearing their hair out," Hays says.

One of those doctors was Sunny Raleigh. Before coming to True North six months ago, Raleigh worked for three-and-a-half years in another practice that followed a typical insurance model.

She says she felt she was merely maintaining the disease process, and too much of her attention was spent filling out paperwork and exam forms, "you know, just making sure that all these extra boxes were checked, just to justify the charge for the visit," she says. "I really struggled with that."

When Raleigh left, she gave up a 401K and guaranteed patient base, to work at True North, which operates as a non-profit. She and the other practioners - who range from physicians and nurse practitioners to acupuncturists and psychotherapists - are essentially freelancers. They drum up their own business, set their own rates and appointment times.

Raleigh says she makes about the same as she used to at her previous job. Patients pay in full at each appointment, but can submit their own insurance claims. After an hour, Cathy Patnaude's appointment is over and Raleigh does a final check-in. "OK - anything else that I have failed to address today? OK. Let me walk you to the front."

Raleigh walks Patnaude to the front desk and hugs her goodbye. The cost of the physical rings in at $260.

The cost may seem steep, but Bethany Hays says it's less than what other doctors charge per hour, and patients get what they pay for. Hays says about half of True North's patients submit their own insurance claims and get at least 60 percent to 80 percent reimbursement.

Patnaude says she expects full reimbursement for her physical - but not for a few months. "The insurance company does have you jump through hoops to get a claim paid. And so, the burden falls back on the patient to keep calling the insurance and resubmitting the paperwork," Patnaude says, "and it hasn't been easy to get claims paid."

But Patnaude says it's worth it. She feels healthier. Raleigh says when patients know what their health care costs - and pay for it - they're more likely to act upon doctors' suggestions. "The fact that you have invested this time and money, you then go home and it kind of resonates within the patient heavier."

Raleigh says she's finally practicing medicine the way she envisioned she would. She and Medical Director Bethany Hays say even as health care changes with the roll out of Affordable Care Act, they believe there will always be a place for this model of health care, where doctors invest time and patients invest money.

Photo:  Patty Wight


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