“I found out after one or two years how burdensome (dealing with insurance is). Even if your claims are denied, 20 percent of them may be denied. I had to hire a team of billing people just to survive. In insurance practices, it's about volume and procedures. I wanted to work for people, not insurance companies,” Gladd said – a decision that caused him to reject Medicaid and Medicare as well.
But he does accept $249 for a one-hour appointment or $149 for a nurse practitioner – fees Gladd insists can actually save patients money if they replace expensive comprehensives policies with health savings accounts and less-expensive insurance that protects them from catastrophic illness or injury.
Some patients are at least partially reimbursed through insurance, but those who find Gladd's fee unaffordable may have an option that was not uncommon before insurance regulations took over: He'll consider bartering his services for something of value in return.
Gladd insists he's spending less time in the office but making as much money as he did when he accepted private and government insurance – with less paperwork and aggravation. But he insists the rejection of a financial bureaucracy that is playing an ever-expanding role in health care is based on far more than dollars and sense. His business model also improves the quality of medicine he can provide.
Trained in family medicine, Gladd started his career in Columbia City in 2004 as a conventional M.D. In 2007 he went to work for Parkview Health as a primary care physician, in large part to escape the paperwork that was bogging down his private practice. But Gladd soon discovered there was a trade-off: he was expected to meet productivity levels that were not necessarily linked to medical outcomes.
It was about then that Gladd decided he needed to lose weight – and in the process discovered the kind of medicine he believes is most compatible with his no-insurance approach but with the human body itself.
“Integrative medicine” combines traditional medicine with alternative treatments, especially the promotion of healthy lifestyles and nutrition. “The idea is to promote health, not manage disease,” said Gladd, noting that developing individual diet and treatment plans for patients requires far more than the seven minutes an average doctor's appointment takes – brevity he said is at least partially dictated by insurance and productivity requirements.
Gladd, who moved into integrative medicine while still at Parkview, opened his own practice in 2010 and said he is living proof the approach works: He dropped from 220 pounds to 175 and relieved his panic attacks mostly through a healthier diet of whole foods, even though “I had probably 15 minutes of training in nutrition in medical school.” In addition to nutrition, integrative medicine also focuses on stress management and digestive health.
Gladd doesn't claim his approach is for everyone. Although he puts information on nutrition and other topics online where people can access it for free, some patients must rely on insurance. And although he will prescribe medication and use other forms of traditional medicine when appropriate, Gladd wants patients to also have a primary care physician.
As the influence of private and governmental regulations on medicine grows, Gladd expects more of his peers to join him in the no-insurance movement. But the real shift, he said, may not occur until the system collapses under its own weight. And when it does happen – and it will – Gladd represents the logical alternative: Market-based medicine. Patients find value in his services, and are willing to pay accordingly.
That's also why Gladd said he won't accept insurance even if the industry became more medicine-friendly. He's not interested in investing time in people who aren't serious about integrative medicine but are willing to make an office visit that will cost them only their $20 co-pay.
Rhonda Arnold, for one, thinks her visits to Gladd's office represented money well spent.
After traditional doctors couldn't successfully treat her daughter's weight loss, Gladd diagnosed a dietary problem and the girl's annual medical claims dropped from 147 to 95 to zero. “I'm a huge fan. Sometimes, insurance gets in the way of
the patient,” she said.
Doctors, too — unless they decide otherwise..