Examples

ServiceMemberNon-memberBlue bookInsurance limitations
Annual PhysicalINCLUDED$130$260 
Wellness PanelINCLUDED   
Chemistries $16$53 
Hgb A1C $10$40(only if at risk for diabetes)
Lipids $26$53 
Vit D $50$180(only if deficient)
CBC $10$42 
TSH $20$60(only if symptomatic)
PSA $40$70(only if you are >50)
EKGINCLUDED$50$100 
TOTALINCLUDED$352$858 

Johnny is 10 years old and was on the merry go round and suffered a gash to his right knee. It is bleeding quite a bit. It is 8:00 at night and he is at College Hill Park.

Option 1 Johnny’s parents take him to the ER where they wait 2.5 hours. The doctor places 5 stitches, and they leave 15 minutes later. The bill is $1000. They then return 10 days later to an insurance based practice and are charged $73 for the stitches to be removed.

Option 2 Johnny’s parents take him to the Urgent Care. The wait is only 45 minutes. The doctor places 5 stitches, and they leave 15 minutes later. The bill is $500. They then return to the Urgent Care and the stitches are removed for free.

Option 3 Johnny’s parents call Dr. Davis’ cell phone. They meet him at Prairie Health & Wellness 10 minutes later. Dr. Davis places 5 stitches, and 15 minutes later they pay their member price of $200. They then return 10 days later for stitch removal which is free.

Cheryl is 55 years old and has been suffering for 10 days from a horrible cough, chills, aches, and some shortness of breath. Her co-workers are very concerned when she struggles to carry on a normal conversation. She is pale and clammy.

Option 1 Her co-worker calls for an ambulance. In the ER she has a full cardiac work-up and is discharged 5 hours later with a diagnosis of acute bronchitis. Ambulance bill is $500. ER bill is $3000.

Option 2 Her co-worker drives her to a traditional insurance based practice. They fortunately have time to evaluate her, and she is diagnosed with acute bronchitis. She is billed $170. She hasn’t met her deductible and is responsible for her insurance negotiated price of $120 with her copay. Her $30 copay doesn’t go towards her deductible nor her maximum out of pocket for the year.

Option 3 Her co-worker drives her to Prairie Health and Wellness, she is seen right away, and diagnosed with acute bronchitis. Cheryl has no copay and since Cheryl is a member the visit is FREE. Cheryl already paid for her 1 year membership in a lump sum from her HSA. That fee she paid was applied toward both her deductible and her out of pocket maximum for the year.