At some point, most people have had a version of this experience…
You go to the doctor for something that seems straightforward. You pay your copay. You get a referral to a specialist. You schedule that appointment, pay another copay, and wait several weeks to be seen. The specialist orders labs and imaging. Each comes with its own bill. The imaging facility is technically in-network, but the radiologist who reads the scan is not (a detail no one mentioned when the order was placed). A few weeks later, an explanation of benefits arrives in the mail that looks nothing like what you expected to pay.
You handled one health issue. You made four appointments. You got three separate bills. You took time off work for each visit.
This is not a story about bad luck. It's a description of how conventional healthcare finance actually works for most patients, and understanding it is the first step to knowing whether a different model might serve you better.
What You're Actually Paying in Conventional Healthcare
The sticker price of healthcare is your monthly premium. But that's rarely where the costs end.
The deductible gap. Most insurance plans, especially the high-deductible plans that have become increasingly common, require you to pay a significant amount out of pocket before your insurance coverage kicks in for most services. Until you meet that deductible, you're effectively paying close to full price for the care you receive.
Copays and coinsurance. Once your deductible is met, you typically still pay a portion of each service, a flat copay for office visits, or a percentage of the total cost (coinsurance) for procedures and specialists. These costs accumulate, particularly for patients managing chronic conditions who see providers regularly.
Specialist costs. A referral from your primary care physician doesn't just mean a new appointment, it means a new cost structure. Specialist copays are typically higher than primary care copays, and specialist visits often trigger additional orders for labs, imaging, or follow-up appointments, each of which carries its own cost.
The surprise bill problem. Even within an in-network facility, individual providers (anesthesiologists, radiologists, pathologists) may be out-of-network. This creates bills patients didn't anticipate and didn't have the opportunity to avoid.
Time as a cost. Conventional healthcare is also expensive in ways that don't appear on an Explanation of Benefits. Time spent waiting for appointments, traveling to multiple providers, following up on referrals, and coordinating between offices is also a cost…particularly when it means time away from work.
The Referral Cascade
One of the most significant cost drivers in conventional primary care is the referral and the cascade it can set off.
When a primary care physician operates under time pressure, with brief appointment slots and high patient volume, the path of least resistance for complex or time-intensive questions is often a specialist referral. This isn't a criticism of individual physicians; it's a structural feature of a model that wasn't designed to give primary care physicians the time to manage complexity themselves.
The result is that conditions which could be managed thoroughly in primary care, things like thyroid disorders, hormonal imbalance, metabolic syndrome, early cardiovascular risk, chronic fatigue, or musculoskeletal complaints to name a few, frequently generate specialist referrals. Each referral is a new copay, a new wait time, and often a new set of labs or tests ordered independently of whatever the primary care physician already ordered.
Patients managing multiple interconnected conditions can find themselves in a cycle of referrals with no single physician synthesizing the full picture and with costs accumulating at each handoff.
What DPC Changes About This Picture
Direct Primary Care is a membership model for primary care that removes the per-visit billing structure entirely. Instead of your physician billing your insurance for each appointment, you pay a flat monthly membership fee directly to the practice. Office visits, physician consultations, and direct access to your doctor are included with no copay, no claim, and no surprise bill for primary care services.
At Madsen Medical, the DPC membership includes:
Same-day or next-day appointments with Dr. Madsen
Appointments long enough to address complex, layered health questions
Direct phone and messaging access to your physician
Physician-led management of BHRT, GLP-1 therapy, and chronic conditions
Continuity of care with the same physician across every visit
Note: Hormone therapies and weight loss medications are prescribed and managed through your membership, but the medications themselves are billed separately. Madsen Medical maintains an in-house pharmacy stocked with many common medications, often available to members at a lower cost than retail pharmacies. We're happy to walk through specifics during your consultation.
The flat-fee model changes the financial relationship you have with your healthcare: there is no financial incentive to keep appointments brief, to defer complex questions, or to refer out what can be managed well in primary care. The cost of your care is predictable. The access is consistent.
What DPC Doesn't Change
DPC is not insurance, and it is not a substitute for insurance. You still need coverage for hospitalizations, emergency care, specialist visits, surgery, and major medical events. Those costs exist in a DPC model just as they do in conventional care, and insurance remains necessary.
DPC membership is an additional monthly cost, not a replacement for your existing coverage. What it replaces is the per-visit billing structure for primary care specifically.
For some patients, the combination of a DPC membership and a higher-deductible insurance plan (which carries lower monthly premiums) can result in a total healthcare spend that is comparable to, or lower than, a traditional insurance plan with conventional primary care. But healthcare finances are individual, and we'd encourage you to run your own numbers.
What we can say is that the DPC model makes the primary care portion of your healthcare costs predictable and the access to your physician better.
The Non-Financial Costs of Conventional Healthcare
Cost conversations in healthcare tend to focus on dollars…which makes sense (ha!). But there are costs that don't appear on any bill.
The cost of deferred care. When appointments are hard to get, patients delay. Concerns get put off until they're impossible to ignore. Things that could have been caught early get caught late. The financial cost of that dynamic often appears much further down the road, in more serious care that is more expensive to treat.
The cost of fragmentation. When no single physician knows your full health picture, you spend real time and energy bridging the gaps. You’re carrying records between providers, re-explaining your history, or following up on referrals that don't communicate with each other. That coordination burden falls on the patient in a fragmented model.
The cost of brief appointments. Fifteen minutes is not enough time to address a complex health question thoroughly. Patients learn to triage their concerns before appointments, leaving some things unasked. Those unasked questions don't go away, they just go unaddressed.
DPC doesn't eliminate every cost. But it substantially reduces these particular ones.
What This Looks Like at Madsen Medical
Dr. Madsen is a Doctor of Osteopathic Medicine with 38 years of medical practice and 36 years serving Chillicothe and Southern Ohio. Madsen Medical has operated as a Direct Primary Care practice since January 2016.
His DO training in whole-body, integrative medicine, combined with the DPC model's unhurried appointments, means he can manage conditions that conventional primary care routinely refers out: hormonal imbalance, metabolic disorders, complex chronic conditions, musculoskeletal complaints, and more. Fewer referrals, in the right clinical context, mean fewer specialist copays, fewer separate appointments, and fewer disconnected providers managing pieces of a picture no one is seeing whole.
The membership is straightforward, the access is real, and the first step is a conversation that we’d love to have with you.
Frequently Asked Questions
Is DPC membership in addition to insurance, or instead of it? In addition to. DPC provides primary care and insurance covers major medical events, hospitalizations, emergency care, and specialist visits. Both are necessary, and they work alongside each other.
Will a DPC membership save me money? It depends on your situation; your current insurance plan, how often you use primary care, whether you're managing conditions that currently generate specialist referrals, and what your time is worth to you. We can walk through how the membership works and what's included; the financial analysis is yours to do with that information.
Are medications included in the membership? Physician management of your prescriptions is included. The medications themselves, including hormone therapies and GLP-1 weight management medications, are billed separately. That said, Madsen Medical has an in-house pharmacy stocked with many common medications, and members can often purchase them at a lower cost than they'd pay at a retail pharmacy.
What does a typical visit look like? Longer than what most patients are used to. Appointments are scheduled with enough time to address your actual questions, review your history, and make decisions together…not to get through a checklist and move on.
How do I find out if the membership makes sense for my situation? The best starting point is a consultation with Dr. Madsen. There is no commitment and no obligation, just a conversation about what you're managing, what you're looking for, and whether this practice is a good fit.
The Case for a Different Model
Conventional healthcare isn't broken because anyone intended it to be this way. It evolved under a set of financial incentives that reward volume and procedure instead of time and continuity. The costs, financial and otherwise, are a predictable outcome of that structure.
DPC is a different structure, with different incentives. The question is whether it's the right fit for you.
Madsen Medical is a Direct Primary Care practice in Chillicothe, Ohio, serving patients throughout Ross County and Southern Ohio. Dr. Madsen, DO, has practiced medicine for 38 years, 36 of them in this community. Direct Primary Care membership is not insurance and does not replace insurance coverage. This post is for general informational purposes only and does not constitute medical, financial, or insurance advice. Consult qualified professionals for guidance specific to your situation.
Call us at (740) 200-3860 | 192 S. Paint Street, Chillicothe, Ohio 45601
