Maine doctors ditch insurance, offer monthly subscriptions for primary care

By Jackie Farwell, BDN Staff

SOUTH PORTLAND, Maine — Roxanne Pettigrow has no health insurance. But the Gorham woman visits her doctor in South Portland every few weeks, paying $50 up front, once per month for regular checkups, office visits and preventive health screenings — care those lacking health coverage often skip.

With her $600 annual subscription, Pettigrow enjoys hour-long visits and email exchanges with her primary care physician, Dr. Michael Ciampi. The South Portland doctor attracted national media attention a year ago for his decision to stop accepting all forms of health insurance, and he began offering the subscription option in mid-January.

Pettigrow saw Ciampi on the news and became one of his first subscription patients, who number about two dozen.

“Dr. Ciampi never looks at his watch, which I find totally amazing,” Pettigrow said, sitting in an exam room after a recent appointment. “He’s the first doctor I’ve ever seen that doesn’t look at his watch.”

Ciampi’s patients can either pay the monthly subscription — which costs $95 per month for an adult couple and $140 per month for a family — or pay for individual services, based on prices Ciampi posts on the practice’s website. Some patients have health coverage, seeking reimbursement from insurers after the fact. Others find paying Ciampi costs less than accumulating high out-of-pocket costs under their health plan or believe he is worth the better care even if he costs more.

“The $50 a month that I pay, for the services I get, is really unbelieveable,” Pettigrow said. “It really is. I think more people should know what he’s offering because there’s so many of us out there that don’t have health care.”

Pettrigrow said she couldn’t afford the $200-plus per month it would have cost her to buy insurance under the Affordable Care Act. She saves about $75 a month by purchasing her prescriptions through Ciampi’s office, which sells many generic medications to its subscription patients at cost.

His office also provides vaccines at cost, or free for subscription patients. Lab work sent out for processing is offered at the practice’s cost, at a savings of 25 to 75 percent compared with local hospital and commercial labs, Ciampi said.

Included in the subscription are annual physicals; office visits for chronic conditions, illnesses, and injuries; some services related to diagnostic testing, such as EKGs and pregnancy tests; draining of abscesses and some joint injections, among other services.

“Anything that would normally happen in a family doctor’s office, it’s all part of the membership,” Ciampi said. “There are no co-payments, there are no deductibles.”

When patients need to visit a specialist, get an X-ray or MRI, or use other services outside Ciampi’s scope, he does his best to send them to doctors and facilities that offer discounts for paying cash.

Symptom of change
Ciampi’s among a small but growing number of physicians, faced with mountains of insurance forms and packed waiting rooms, who are rejecting the traditional health insurance model.

Independent physicians like him, who don’t work for hospitals with large billing departments to handle paperwork, appear particularly drawn to cutting out the insurance middleman. Freeing themselves of insurance overhead saves both time and money, as doctors can employ fewer people to handle billing. That savings allows them to lower fees, physicians say.

An estimated 1,500 to 3,000 physicians nationally are offering “direct primary care,” according to Garrison Bliss, co-founder of Qliance, a lower-cost concierge medicine firm based in the Seattle area. The umbrella term includes a variety of arrangements under which providers have direct financial arrangements with patients.

Bliss wrote in an email that at least the same number are pursuing “concierge practices,” a similar model in which patients pay up front for access to a doctor. Concierge medicine has developed a reputation for celebrity-style treatment at high prices, though some practices offer more affordable rates. More than 60 percent of concierge and direct primary care memberships cost less than $135 per month, according to the trade publication Concierge Medicine Today.

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