$0 Primary Care Visits Are Now an Insurer's Pitch to Employers
On October 7, Centene announced that some Ambetter members in Indiana and Missouri will get $0 primary care visits, $0 lab services, and virtual primary care starting in the 2027 plan year. The care comes through Marathon Health. The plans are sold through what Centene now calls CHOICE Arrangements, the new name for ICHRA, where an employer hands each worker a set amount of money and the worker picks an individual plan.
Read that slowly. One of the biggest insurance companies in the country looked at everything it could put in the window for employers, and it picked primary care with no copay and no lab bill.
Direct care doctors have been saying this for well over a decade. Take the toll booth off the front door and people walk through it. They come in for the cough before it is pneumonia. They ask about the blood pressure before it is a stroke. The cheapest visit in medicine is the one that happens early.
So I am glad. Honestly. When an insurer starts selling your idea, you have won the argument.
But $0 is not a price. It is a location. The cost did not disappear. It moved into the premium, where nobody sees it on the day of the visit. And read the fine print in the announcement: select counties, eligible members, starting in 2027. The relationship belongs to the contract between the plan and the vendor. Change plans next fall and your doctor may not come with you.
Direct care keeps the same front door and changes who holds the key. The price is posted on the door. One monthly membership. Your doctor's own phone number. Wholesale labs and medications at what they actually cost. If you switch insurance, your doctor stays. Since January 1, HSA money can even pay a qualifying membership, up to $150 a month for one person or $300 for a family.
And here is the part employers should hear before open enrollment closes: you do not have to wait for an insurer to pick your county. An ICHRA, or whatever we are calling it this year, pairs just fine with a direct care membership. Give your people the individual plan for the big stuff and a doctor they can text for everything else.
Free at the counter is nice. Owning the relationship is better.
READ MORE: investors.centene.com/2026-10-07-Ambetter-Health-Solutions-and-Marathon-Health-Expand-Access-to-Primary-Care-for-Members-in-Indiana-and-Missouri
$410 for 4 Hours in the ER Waiting Room
Autumn Daniels had a migraine for a week. Urgent care gave her a shot of Toradol and told her to go to the emergency room if it did not get better. It did not.
So in April her sister drove her to Carle Foundation Hospital in Urbana, Illinois. A staffer checked her pulse, temperature, and blood pressure. Then they sent her back out to the waiting room. She was vomiting every 10 minutes. Her sister asked for an ice pack. No ice pack. After 4 hours with no doctor in sight, her sister took her to another hospital, where she was seen and treated.
Carle sent her a bill anyway. $410. "Emergency Room Level 1." KFF Health News has the story in this month's Bill of the Month.
The explanation came by email. Starting March 1, 2026, ER visits may result in charges even if you are never seen by a provider. Your visit begins at registration. The hospital is paying for staff, space, and equipment whether you stay or not. Her health plan denied the claim because she left against medical advice. So the bill is hers.
Here is the part every doctor should read twice. The bill carried code 99281, an evaluation and management code. The AMA's own CPT guide says triage alone is not an E/M service and cannot be reported with an E/M code. An AMA spokesperson said the physician charge for that code would generally be significantly less than $410, and the hospital likely rolled a facility fee into it. She asked for an itemized bill. She never got one.
It is not the first time. In 2023 another Carle hospital billed a mother $445 for a covid and flu swab on her toddler after they left without treatment.
I am not shocked. When the revenue lives in the code, the code finds its way onto the bill. Even when the only service was a chair.
Now look at the path that put her in that chair. A week of migraine. Urgent care. Then one ER. Then a second ER. That is 3 front doors, and none of them were hers. Nobody who knew her history. Nobody she could text the morning it got worse and ask what now.
That is the gap direct care closes. A patient with a week of migraine calls her own doctor. She is seen that day, or she gets a call back and a plan. Many direct care offices keep the common migraine and nausea medications on the shelf at wholesale cost. If she truly needs the ER, her doctor tells her which one and calls ahead. The membership price is on the door. The waiting room does not send a bill.
Keep insurance for the wreck. But a chair should not cost $410.
READ MORE: kffhealthnews.org/health-care-costs/emergency-room-not-treated-still-charged-illinois-bill-of-the-month-september-2026/
24 Warning Letters Say a Partial Price Is a Deceptive Price
This week the Federal Trade Commission sent warning letters to 24 of the largest health care companies in the country. The message was simple. A price that leaves out the doctor's fee or the facility fee may not be a price at all. It may be deception.
The FTC didn't say who got the letters. It did post the template. Price is a "material term," it says, and a disclosure can still mislead when it leaves out "certain charges like physician fees or facility fees," or covers only part of the expected care. Patients can reasonably believe they were told the total. They weren't.
The part I'd underline: following the CMS price transparency rules is not a safe harbor. Hospitals have been posting machine-readable files since 2021 and calling that compliance. The FTC is saying the file is the floor. The patient on the phone asking what this will cost is the real test.
Anybody who has had a scheduled procedure knows how this goes. You get a number. Then the surgeon's bill. Then anesthesia. Then pathology. Then a facility fee from a building you thought was a doctor's office. The quote was the tip. The bill was the rest of the iceberg.
I am not shocked. When the price is split across several bills, nobody has to own the total. Nobody ever has to say the whole number out loud.
I am not anti-insurance. Keep a policy for the wreck. But a scheduled knee scope or a colonoscopy isn't a wreck. It's something you can plan, compare, and shop, if somebody will tell you the real price before you show up.
Direct care starts from the other end. One monthly fee. Labs and medications priced before you buy them. When we send a patient out for a procedure, we look for the places that quote one number that covers everything. The number on the door is the number you pay.
FTC Chairman Andrew Ferguson told the companies to review their price disclosures and take swift corrective action. Fine. Patients have been getting the warning for years. It just usually arrives in the mail weeks after the procedure, in separate envelopes.
24 letters is a start. A price is the whole bill, or it isn't a price.
12,000 Steps a Day, and Teens Feel Better
Here is some good news.
Researchers followed more than 5,500 kids, average age 12, with Fitbits, brain scans, and mental health check-ins. After 1 year, the teens taking 12,000 or more steps a day had fewer mental health symptoms than the ones taking fewer than 5,000.
It went beyond mood. More steps lined up with greater thickness in 2 brain regions tied to movement, attention, and decision-making. The researchers think walking may release dopamine and serotonin while lowering cortisol and inflammation, which may help ease anxiety and depression.
Dr. Claudine Higdon, a child and adolescent psychiatrist at Northwell Health who reviewed the results, put it simply: "Kids: Movement is so key. Just any little bit of walking can make a big difference."
I love this one because the prescription costs nothing. No prior authorization. No copay. No waiting list. Just a pair of shoes and a reason to get outside.
It is also exactly the kind of conversation a real primary care visit should have room for. When you have time with your doctor, you can talk about what keeps kids well, not just what gets billed. Sleep. Screens. Walking the dog after dinner.
Parents, take the walk with them.
The study was published October 1 in JAMA Network Open, led by Divyangana Rakesh at King's College London.
Source: www.healthday.com/health-news/mental-health/do-more-steps-mean-better-mental-health-for-teens
The Goods You Can't Check
Your car makes a noise. You take it to the shop. The mechanic says it needs a new part. You pay. The noise stops.
Did you need the part? You don't know. You will never know.
Your doctor says you need a test. Then a follow-up. Then a prescription. You feel better. Or you don't.
Did you need all of it? Did you get all of it? Was the price fair? You don't know that either.
Economists have a name for this. Most people have never heard it. They're called credence goods.
There are three kinds of things we buy.
Search goods you can judge before you buy. A shirt. A couch. You look, you touch, you decide.
Experience goods you can judge after. A restaurant meal. A haircut. You find out when you're done.
Credence goods you can't judge even after. The term goes back to two economists, Michael Darby and Edi Karni, in 1973. The classic examples are the mechanic and the doctor. The person who tells you what you need is the same person who sells it to you. You're left with one tool. Trust.
That's not an insult to doctors or mechanics. Most are honest. But the setup invites trouble. Economists list three ways it goes wrong. You get more than you needed. You get less than you needed. Or you get charged for more than you got.
Researchers have tested this. In one study, people took identical broken phones to repair shops in Turkey. When they said "I don't know what's wrong," they paid more than 40% more than when they named the broken part. Same phone. Same fix. The only difference was what the customer knew.
Now add insurance.
You'd think a third party would help. Someone big, checking the bill.
It doesn't work that way. In a study published in PNAS, researchers took computers with the same small, simple problem to 61 repair shops in Austria. The average bill was about 70 euros. When the customer mentioned that insurance would cover it, the bill went up more than 80%. Extra parts. Extra hours. When asked why, the shops' top answer was that insured customers don't watch the cost, because somebody else pays.
That was computers. But the economists who ran it put medical care right next to repair work as a prime example of a credence good.
Here's the problem. The insurance company can't verify the care either. It wasn't in the room. So it does what it can. It adds forms. Codes. Prior authorizations. Denials. Paperwork in place of trust.
The patient still can't check. The doctor spends the afternoon proving things to a stranger. And the price climbs to pay for all the checking.
I am not anti-insurance. Keep a policy for the wreck. But for everyday care, insurance didn't close the trust gap. It added a third party who can't see inside it either.
So what do you do when the customer can't check your work?
You make it so they don't have to.
You go overboard on the things they care about most. You take away the reasons to cheat before anyone has to wonder.
At AtlasMD, that looks like this. Unlimited visits, so there's no reason to book you more or squeeze you in less. No copays. All procedures free. Meds and labs at cost plus 10%, with the price posted where you can see it.
Unlimited visits take away the pull to overtreat or undertreat. A posted cost-plus price takes away the room to overcharge. You don't have to trust my diagnosis of your bill. You can read it.
None of that is easy as a business. Doing less for more is easier. It's also not fair.
A credence good asks the customer for faith. The least we can do is earn it on the parts they can see.
You shouldn't need faith to read a bill. So we post ours.
Sources:
Kerschbamer, Neururer & Sutter, PNAS (2016): www.pnas.org/doi/10.1073/pnas.1518015113
Phone repair field experiment, Management Science: pubsonline.informs.org/doi/10.1287/mnsc.2022.02666
Investopedia, Credence Good: www.investopedia.com/terms/c/credence-good.asp