When you visit a primary care doctor, specialist, urgent care, or ER and you have traditional insurance, you pay a co-pay. But that's the cost of leaving the doctor's office or facility. A few weeks later, you'll get bills for the actual cost of the visit. If you have a deductible, you’ve got to spend all of that until you can ask “will my insurance pay for this?” The average deductible today is $1,500 if you get your insurance through an employer or $3,500 if you get it through an Obamacare plan.
Most people don't spend their entire deductible, so for most people getting care is 100% paid for out of pocket.
If your deductible is $1,000: 70% chance of not spending all $1,000
If your deductible is $3,000: 80% chance of not spending all $3,000
If your deductible is $5,000: 90% chance of not spending all $5,000
How much do typical services cost (co-pay + bills)?
- Primary care doctor = $200
- Specialist = $300
- Urgent care center = $350
- ER = $2,000
The bills you receive are for as much as they can bill. That's the traditional healthcare business model.
Use Sherpaa before you visit a doctor, urgent care center, or ER in person.
The vast majority of the time, we can diagnose and treat you without you having to be seen by a local doctor or facility helping you avoid the co-pays + the bills.
If you've got insurance + Sherpaa and you haven't yet spent all of your deductible:
Here's what you avoid when Sherpaa treats you virtually:
- Co-pays + bills for $200 primary care doctor visits
- Co-pays + bills for $300 specialist visits
- Co-pays + bills for $350 urgent care center visits
- Co-pays + bills for $2,000 ER visits
Here's what you will pay for if you get care from Sherpaa doctors:
- Sherpaa access (instead of $200 PCP or $350 urgent care visits, you pay a $99 flat fee for 30 days of unlimited care or $270 for unlimited care for a year)
- Any tests your Sherpaa doctor orders (counts toward your deductible)
- Any medications your Sherpaa doctor prescribes (counts toward your deductible)
- Any specialist, urgent care, or ER visits your Sherpaa doctor refers you to (counts toward your deductible)
If you have spent all $1,500 of your deductible, your insurance starts to cover most of your bills:
Here's what you will then start paying:
- Sherpaa access ($99 flat fee for 30 days of unlimited care or $270 for unlimited care for a year)
- Co-pays for all in-person office, urgent care, and ER visits
- Co-insurance for all bills for in-person doctor visits, tests, procedures, medications, etc up to your plans's stated out-of-pocket maximum.
Once you've reached your out-of-pocket maximum, your insurance will theoretically start covering all of your medical bills. But if you've spent your entire deductible, you've likely spent it on doctor, urgent care, and ER visits, and 70% of those could have been handled virtually via Sherpaa.